State policy environment and delayed or forgone care among children with special health care needs
State policy environment and delayed or forgone care among children with special health care needs
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DOI：
10.1007/s10995-007-0296-y
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发表时间：
2008-11-01
影响因子：
2.3
通讯作者：
Kuhlthau, Karen
中科院分区：
文献类型：
--
作者：
Gnanasekaran, Sangeeth K.;Boudreau, Alexy Arauz;Kuhlthau, Karen
目的评估居住在公共保险计划更慷慨的州的特殊医疗保健需求（CSHCN）儿童报告延迟或放弃护理的可能性是否更小。方法在控制个体特征的基础上，采用多水平模型对国家政策特征进行评价。我们使用了2001年CSHCN全国调查的个人层面的数据（N = 33，317）与国家层面的数据，其中包括国家的公共保险计划（医疗补助资格和注册，医疗补助，SCHIP和标题V的支出，收入资格水平），国家贫困水平和提供者供应（包括儿科初级保健和专业提供者）的措施。我们还纳入了一个变量，用于需要机构级护理的CSHCN的州豁免。结果CSHCN的延迟或放弃护理在不同州之间存在显著差异，不受个体特征的影响。在所有研究的州特征中，只有医疗补助收入资格水平影响了延迟护理的风险。生活在收入资格门槛较高或资格水平较慷慨的州的CSHCN不太可能经历延迟护理（OR 0.89（0.80，0.99）; P
Objective To evaluate if children with special health care needs (CSHCN) residing in states with more generous public insurance programs were less likely to report delayed or forgone care. Methods We used multilevel modeling to evaluate state policy characteristics after controlling for individual characteristics. We used the 2001 National Survey of CSHCN for individual-level data (N = 33,317) merged with state-level data, which included measures of the state's public insurance programs (Medicaid eligibility and enrollment, spending on Medicaid, SCHIP and Title V, and income eligibility levels), state poverty level and provider supply (including pediatric primary care and specialty providers). We also included a variable for state waivers for CSHCN requiring institutional level care. Results Delayed or forgone care significantly varied among CSHCN between states, net of individual characteristics. Of all the state characteristics studied, only the Medicaid income eligibility levels influenced the risk of experiencing delayed care. CSHCN living in states with higher income eligibility thresholds or more generous eligibility levels were less likely to experience delayed care (OR 0.89(0.80,0.99); P