Adolescent health insurance coverage: Recent changes and access to care
Adolescent health insurance coverage: Recent changes and access to care
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DOI：
10.1542/peds.104.2.195
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发表时间：
1999-08-01
期刊：
影响因子：
8
通讯作者：
Irwin, CE
中科院分区：
文献类型：
--
作者：
Newacheck, PW;Brindis, CD;Irwin, CE
Objective.为了评估青少年的健康保险状况，青少年医疗保健覆盖率的趋势，保险覆盖率的人口和社会经济相关因素，以及保险覆盖率在影响获得和使用医疗保健方面的作用，这些结果共同提供了青少年健康保险覆盖率的当前和全面的概况。我们分析了14252名青少年的数据，年龄10至18岁，包括在1995年全国健康访谈调查。这项调查获得了关于保险覆盖范围和获得和利用的若干措施的信息，包括通常的护理来源、通常的护理来源的地点、错过或延迟护理的迹象以及青少年使用门诊医生服务的情况。我们进行了多变量分析，以评估年龄，性别，种族，贫困状况，家庭结构，家庭规模，居住地区，大都市居民身份和健康状况对保险覆盖可能性的独立关联。我们进行了双变量和多变量分析，以确定保险覆盖范围是如何与调查中获得的每一个访问和利用措施。我们还使用1984年、1989年和1995年版的全国健康访谈调查研究了健康保险覆盖率的趋势。1995年，估计有14.1%的青少年没有保险。年龄较大的青少年、少数民族、低收入家庭的青少年和单亲家庭的青少年没有保险的风险更高。与有保险的青少年相比，没有保险的青少年缺乏通常护理来源的可能性是五倍，未满足健康需求的可能性是四倍，一年中没有医生联系的可能性是两倍。1984年至1995年期间，参加某种形式健康保险的青少年的百分比基本保持不变。在此期间，私人健康保险的患病率下降，而公共健康保险的患病率上升。这项研究表明，健康保险作为青少年获得和使用保健服务的决定因素至关重要。它还表明，在过去15年中，在减少未投保青少年人口规模方面几乎没有取得进展。新的州儿童健康保险计划可能会大大改善青少年获得护理的机会，但前提是各州对没有保险的青少年实施有效的推广和入学战略。
Objective. To assess the health insurance status of adolescents, the trends in adolescent health care coverage, the demographic and socioeconomic correlates of insurance coverage, and the role that insurance coverage plays in influencing access to and use of health care, Together, the results provide a current and comprehensive profile of adolescent health insurance coverage.Methods. We analyzed data on 14 252 adolescents, ages 10 to 18 years, included in the 1995 National Health Interview Survey. The survey obtained information on insurance coverage and several measures of access and utilization, including usual source of care, site of the usual source of care, indications of missed or delayed care, and use of ambulatory physician services by adolescents. We conducted multivariate analyses to assess the independent association of age, sex, race, poverty status, family structure, family size, region of residence, metropolitan resident status, and health status on the likelihood of insurance coverage. We conducted bivariate and multivariate analyses to ascertain how insurance coverage was related to each of the access and utilization measures obtained in the survey. We also examined trends in health insurance coverage using the 1984, 1989, and 1995 editions of the National Health Interview Survey.Results. An estimated 14.1% of adolescents were uninsured in 1995. Risk of being uninsured was higher for older adolescents, minorities, adolescents in low-income families, and adolescents in single parent households. Compared with their insured counterparts, uninsured adolescents were five times as likely to lack a usual source of care, four times as likely to have unmet health needs, and twice as likely to go without a physician contact during the course of a year. Between 1984 and 1995 the percentage of adolescents with some form of health insurance coverage remained essentially unchanged. During this period, the prevalence of private health insurance decreased, while the prevalence of public health insurance increased.Conclusions. This study demonstrates the critical importance of health insurance as a determinant of access to and use of health services among adolescents. It also shows that little progress has been made during the past 15 years in reducing the size of the uninsured adolescent population. The new State Children's Health Insurance Program could lead to substantial improvements in access to care for adolescents, but only if states implement effective outreach and enrollment strategies for uninsured adolescents.