How Health Insurance Status Affects Persons with Disabilities

描述：医疗保险为美国医疗保健系统提供了重要的财务渠道。2003年，估计有4500万人(占人口的15.6%)缺乏医疗保险，造成与健康下降和预期寿命降低有关的巨大的个人和社会成本。某些亚群特别容易受到没有保险的影响。其中一个子群体是工作年龄的残疾成年人，他们无法获得“有报酬”的工作。根据2000年十年一次的人口普查，16岁的有2,130万人(11.9%)报告说，他们的身体或精神状况使他们难以工作。认识到他们的需要，社会“安全网”健康保险方案针对这一群体--医疗保险和医疗补助，在符合社会保障残疾和其他资格标准的人之后获得。然而，我们使用2000年医疗支出小组调查(MEPS)进行的初步分析发现，在报告有严重感官或身体残疾(视力、听力或使用腿、手臂或手的困难)的工作适龄人士中，18.7%的人在前一年的某些时间没有医疗保险，而没有任何此类损害的人的这一比例为14.7%。尽管如此，平均而言，这些人比其他人有更大的健康相关需求，产生更高的成本。这项为期两年的研究的总体具体目标是使用1998年至2003年的MEPS数据来：(1)充分探索有感觉和身体障碍的劳动年龄者的医疗保险经历；以及(2)检查他们的医疗保险状况 涉及服务使用、支出、获得护理的机会和满意度以及自我报告的健康和功能结果。我们将重点关注欧洲议会议员的家庭部分，该部分登记了具有全国代表性的平民、非医疗机构美国居民的样本，并在两年半的时间里对他们进行了5轮调查。利用欧洲议会议员收集的丰富数据及其纵向设计，我们还将寻找随着时间的推移，感官和身体障碍者的医疗保险体验的趋势，以及启用和取消医疗保险对个人的影响。我们的最终目标是利用这些信息来提高向这一潜在昂贵人群提供的护理的效率和质量。这一目标涉及保健研究和质量机构的目标，该机构已将残疾人确定为其优先群体之一。

DESCRIPTION: Health insurance provides critical financial access to the U.S. health care system. In 2003, an estimated 45 million persons (15.6% of the population) lacked health insurance, generating enormous personal and societal costs related to diminished health and lowered life expectancies. Certain subpopulations are particularly susceptible to being uninsured. One such subgroup is working-age adults with disabilities that prevent them from "gainful" employment. According to the 2000 decennial census, 21.3 million persons (11.9%) age 16-64 report having some physical or mental condition that makes it hard for them to work. Recognizing their needs, social "safety net" health insurance programs target this population - Medicare and Medicaid, obtained after persons meet Social Security disability and other eligibility criteria. However, our preliminary analyses using the 2000 Medical Expenditure Panel Survey (MEPS) found that 18.7% of working-age persons reporting major sensory or physical disabilities (difficulties with vision, hearing, or using legs, arms, or hands) had no health insurance during some part of the prior year, compared with 14.7% of those without any such impairment. Nonetheless, on average, these individuals have greater health-related needs and generate higher costs than do other persons. The overall specific aims of this two-year study are to use MEPS data from 1998 through 2003 to: (1) explore fully the health insurance experiences of working age persons with sensory and physical impairments; and (2) examine how their health insurance status relates to service use, expenditures, access to and satisfaction with care, and self-reported health and functional outcomes. We shall focus on the Household Component portion of MEPS, which enrolls a nationally-representative sample of civilian, noninstitutionalized, U.S. residents and administers 5 rounds of surveys to them over 2 1/2 years. Using the richness of the data gathered by MEPS and its longitudinal design, we shall look also for trends over time in health insurance experiences for persons with sensory and physical impairments, as well as the consequences for individuals of transitioning on and off health insurance. Our ultimate goal is to use this information to improve the efficiency and quality of care provided to this potentially expensive population. This goal addresses the objectives of the Agency for Healthcare Research and Quality, which has identified persons with disabilities as one of its priority populations.