How Health Insurance Status Affects Persons with Disabilities

描述：健康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4 500万人（占人口的15.6%）没有医疗保险，造成与健康状况下降和预期寿命降低有关的巨大个人和社会成本。某些亚群体特别容易没有保险。其中一个亚群体是适龄工作的残疾成年人，他们无法从事“有报酬的”工作。根据2000年十年一次的人口普查，年龄在16-64岁之间的2130万人（11.9%）报告有某种身体或精神状况使他们难以工作。认识到他们的需求，社会“安全网”健康保险计划针对这一人群——医疗保险和医疗补助，在人们满足社会保障残疾和其他资格标准后获得。然而，我们利用2000年医疗支出小组调查（MEPS）进行的初步分析发现，报告有重大感官或身体残疾（视力、听力或使用腿、手臂或手的困难）的工作年龄人员中，有18.7%在前一年的某些时候没有健康保险，而没有任何此类残疾的人中，这一比例为14.7%。然而，平均而言，这些人比其他人有更大的健康相关需求，并产生更高的费用。这项为期两年的研究的总体具体目的是利用1998年至2003年的MEPS数据：(1)充分探索有感官和身体障碍的工作年龄人员的健康保险经历；(2)考察他们的健康保险状况

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.