Preventive care for children in low-income families: How well do Medicaid and State Children's Health Insurance Programs do?
Preventive care for children in low-income families: How well do Medicaid and State Children's Health Insurance Programs do?
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DOI：
10.1542/peds.2006-3520
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发表时间：
2007-12-01
期刊：
影响因子：
8
通讯作者：
Kenney, Genevieve M.
中科院分区：
文献类型：
--
作者：
Perry, Cynthia D.;Kenney, Genevieve M.
OBJECTIVE.由健康行为引起或加剧的儿童健康问题仍然是儿童医疗支出的主要原因。我们研究了低收入儿童接受临床医生建议的情况，比较了有公共保险的儿童与有私人保险的儿童，以及部分或全年没有保险的儿童。我们使用2001年至2003年医疗支出面板调查数据中3至17岁且生活在收入<联邦贫困线250%的家庭中的儿童来估计收到预防建议的线性概率模型。主要的观察指标是接受临床医生关于健康饮食、体育活动、在家中吸烟的有害影响、在车内适当的安全约束以及使用自行车头盔的建议。我们还检查了接受临床医生建议的2个相关障碍：儿童在过去一年中是否有任何预防性护理访问，以及儿童是否有医院急诊科以外的常规护理来源。公共保险的儿童比私人保险，全年无保险的儿童和部分一年无保险的儿童更有可能在过去一年中进行预防保健访问，但无论健康保险组，许多儿童都没有预防保健。即使有条件的预防保健访问，48%没有收到临床医生的建议，在任何领域的测量，和41%的超重儿童被告知既不健康的饮食，也不运动在过去的一年。在医疗补助和州儿童健康保险计划中招收更多未投保的儿童可以提高家庭获得有关健康行为和伤害预防的建议的机会;然而，全年投保的儿童中有近一半没有从他们的临床医生那里得到重要的建议。
OBJECTIVE. Child health problems that are caused or exacerbated by health behaviors remain a leading cause of medical spending for children. We examined receipt of clinician advice by low-income children, comparing children who had public insurance with those who had private insurance, as well as with children who were uninsured for part or all of the year.METHODS. We used children who were aged 3 to 17 and living in families with incomes of < 250% of the federal poverty level in the Medical Expenditure Panel Survey data from 2001 to 2003 to estimate linear probability models on receipt of preventive advice. The main outcome measures were receipt of clinician's advice about healthy eating, physical activity, the harmful effects of smoking in the home, proper safety restraints in a car, and use of a bicycle helmet. We also examined 2 related barriers to receiving clinician advice: whether the child had any preventive care visits in the past year and whether the child had a usual source of care other than a hospital emergency department.RESULTS. Publicly insured children were more likely than privately insured, full-year-uninsured children, and part-year-uninsured children to have had a preventive care visit in the past year, but regardless of health insurance group, many children went without preventive care. Even conditional on having had a preventive care visit, 48% did not receive clinician advice in any of the areas measured, and 41% of the overweight children were advised about neither healthy eating nor exercise in the past year.CONCLUSIONS. Enrolling more uninsured children in Medicaid and State Children's Health Insurance Programs could improve the chances that families receive advice about health behaviors and injury prevention; however, nearly half of the children who were insured for the entire year did not receive important advice from their clinicians.