在美国分散的医疗系统中, 儿童的保险动态
Ye Shen1,2, Benjamin D Sommers3,4, Laura A Hatfield5
1Interfaculty Initiative in Health Policy, Harvard University, Cambridge, Massachusetts.
JAMA
|September 24, 2025
概括
到了18岁, 大多数美国儿童与医疗补助或CHIP互动, 国家政策对儿童产生重大影响
科学领域:
- 医疗服务研究
- 公共卫生政策
- 儿童健康结果
背景情况:
- 美国儿童医疗保险是一个复杂的公共和私人保险组合,
- 了解儿童的长期保险经验,包括医疗补助,CHIP和无保险,对于政策评估至关重要.
- 疫情前的数据为评估不断变化的医疗保健政策对儿童健康覆盖的影响提供了至关重要的基准.
研究的目的:
- 估计医疗保险覆盖的动态,特别是医疗补助或儿童医疗保险计划 (CHIP) 的入学和整个儿童期的无保险期.
- 在美国"负担得起的医疗保健法" (ACA) 后和疫情前政策条件下分析这些保险动态.
- 为评估未来医疗补助政策变化对儿童医疗保险的潜在影响建立基准.
主要方法:
- 一个微模拟模型预测每月保险覆盖10万个模拟的美国儿童从出生到18岁.
- 综合了2015年至2019年的国家数据集,包括出生记录和调查数据 (MEPS,SIPP).
- 动态预测因素,如家庭收入,保险历史,状态和年龄的月度模拟,以及不确定性间隔的引导.
主要成果:
- 据估计,在18岁时,有61%的美国儿童参加医疗补助或CHIP,而42%的人没有保险.
- 约有26%的儿童在整个童年期间保持了持续的就业或其他非公共保险.
- 在没有扩张的州中,出生在医疗补助/CHIP的儿童的无保险率较高 (59%),相比扩张的州 (36%),特别是在限制资格标准的州.
结论:
- 在疫情前,近四分之三的美国儿童使用公共补贴保险或在18岁时没有保险.
- 儿童无保险的州级差异凸显了国家医疗补助政策的重要影响.
- 这些发现强调了国家特定的医疗补助政策在塑造儿童医疗保险获取和连续性的重要性.
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