为贫困儿童提供护理服务. 分开和不平等的?
R F St Peter1, P W Newacheck, N Halfon
1Robert Wood Johnson Clinical Scholars Program, University of California, San Francisco 94143-0903.
JAMA
|May 27, 1992
概括
医疗补助改善了贫困儿童获得常规护理的机会,但与其他儿童相比,他们不太可能在医生办公室接受护理,护理连续性也较低.
科学领域:
- 医疗服务研究 医疗服务研究
- 儿科健康 儿科健康
- 公共卫生政策 公共卫生政策
背景情况:
- 获得预防护理对于儿童发育和长期健康结果至关重要.
- 医疗补助计划是美国低收入家庭的重要公共医疗保险计划.
- 了解医疗补助计划儿童的护理利用模式对于政策评估至关重要.
研究的目的:
- 检查医疗补助计划覆盖范围对预防性护理使用,护理地点和贫困儿童的连续性的影响.
- 为了比较医疗补助覆盖和没有医疗补助覆盖的儿童的护理准入和连续性.
主要方法:
- 分析了1988年国家儿童健康访谈调查中17,710名美国儿童的全国代表性样本.
- 评估通常的护理来源,访问的及时性,通常的护理地点和护理的连续性.
- 美国家庭的分层集群抽样确保了具有代表性的参与者池.
主要成果:
- 与没有保险的贫困儿童相比,有医疗补助的贫困儿童的例行护理来源 (91%对78%) 和及时的例行访问 (84%对69%) 的比例更高.
- 然而,在医疗补助计划中注册的儿童不太可能在医生办公室接受常规护理 (56%对82%) 并且更容易在常规护理和病人护理之间存在连续性差距 (18%对6%).
- 在社区诊所接受护理的儿童更有可能有不同的位置进行例行和病人的护理,并利用急诊室进行病人的护理.
结论:
- 医疗补助计划提高了低收入儿童获得常规预防护理的机会.
- 尽管医疗补助获得改善,但与贫困线以上的儿童相比,医疗补助并不能保证同等的护理地点或连续性.
- 正在进行的政策调整可能会减轻一些差异,但预计在护理提供方面会持续存在不平等.
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