Underinsurance in primary care: A report from the State Networks of Colorado Ambulatory Practices and Partners (SNOCAP)
Underinsurance in primary care: A report from the State Networks of Colorado Ambulatory Practices and Partners (SNOCAP)
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DOI：
10.3122/jabfm.2008.04.080001
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发表时间：
2008-07-01
影响因子：
2.9
通讯作者：
Westfall, John M.
中科院分区：
文献类型：
--
作者：
Voorhees, Kenton;Fernald, Douglas H.;Westfall, John M.
背景：国家和州层面对未参保人群给予了相当多的关注。还有许多美国人拥有健康保险，但无法负担推荐的护理费用，并被认为保险不足。本研究的目的是确定在初级保健诊所就诊的患者中保险不足的发生率。方法：3 个基于实践的研究网络中 37 个初级保健诊所的患者完成了一项调查，以了解那些拥有完整 12 个月保险（包括私人保险、医疗保险和医疗补助）的患者中保险不足的发生率。保险不足是指患者因无力承担而延迟或遗漏了推荐的护理。结果：在全年拥有保险的人中，36.3% 的人保险不足。在保险不足的人中，50.2% 的人认为自己的健康受到影响，因为他们无法负担推荐的医疗服务，这一比例与未投保的人相似。 结论：在评估初级保健办公室的保险不足情况时，使用基于患者自我报告的经验定义，说明尽管有保险，但他们无法支付推荐的医疗保健费用，患病率相当高。对于初级保健医生来说，重要的是要了解，尽管有保险，但很大一部分患者可能由于成本原因而不会遵循他们的建议。在考虑医疗保健改革时，这也具有重大意义，特别是考虑到这些患者报告说，他们的健康状况与未参保的人相同。
Background: There has been considerable focus on the uninsured from national and state levels. There are also many Americans who have health insurance but are unable to afford their recommended care and are considered underinsured. This purpose of this study was to determine the prevalence of underinsurance among patients seen in primary care clinics.Methods: Patients in 37 primary care practices in 3 practice-based research networks completed a survey to elicit the prevalence of underinsurance among those who had insurance for a full 12 months, including private insurance, Medicare, and Medicaid. Being underinsured was based on patients reporting the delay or omission of recommended care because of their inability to afford it.Results: Of those with insurance for a full year, 36.3% were underinsured. Of those who were underinsured, 50.2% felt that their health suffered because they could not afford recommended care, a rate similar among those who were uninsured.Conclusions: When evaluating underinsurance in primary care offices, using an experiential definition based on self-reports of patients about their inability to pay for recommended health care despite having insurance, the prevalence is quite high. It is important for the primary care physician to understand that a substantial percentage of their patients may not follow through with their recommendations because of cost, despite having insurance. This also has significant implications when considering health care reform, particularly considering that these patients reported that their health suffered at a rate equal to that of the uninsured.