在明尼苏达州,谁还没有保险? 从国家改革努力中吸取教训
1Institute for Health Services Research, School of Public Health, University of Minnesota, Minneapolis 55455, USA. callx001@gold.tc.umn.edu
JAMA
|October 27, 1997
概括
明尼苏达医疗保险保持了低的无保险率,并改善了儿童获得医疗保险的机会. 国家补贴的计划对儿童有效,但对单身成年人不那么有效.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 公共卫生政策 公共卫生政策
- 医疗保健经济学 医疗保健经济学
背景情况:
- 国家卫生改革举措对于解决无保险问题至关重要.
- 了解像MinnesotaCare这样的计划的影响对于国家政策至关重要.
- 追踪无保险率,特别是弱势群体的无保险率,为公共卫生战略提供了信息.
研究的目的:
- 评估明尼苏达州的医疗改革努力,重点关注无保险率和明尼苏达医疗的有效性.
- 分析1990年至1995年间儿童获得医疗保险的变化.
- 评估明尼苏达医疗在为其目标人口提供服务方面的成功及其对更广泛改革的影响.
主要方法:
- 利用了1990年,1995年和1994年进行的三次横截面电话调查.
- 在全州调查中采用2阶段随机抽样,在明尼苏达医疗保险注册人群中采用分层随机抽样.
- 分析了无保险费率的变化,使用每项全州调查中超过10,000名受访者的数据.
主要成果:
- 明尼苏达州的无保险率从1990年至1995年保持在6%的稳定水平,与全国增长形成鲜明对比.
- 超过12个月没有保险的儿童比例显著下降 (5.2%至3.1%).
- 单身成年人的无保险率稳定在11%左右;没有发现程序游戏或私人市场侵蚀的证据.
结论:
- 明尼苏达医疗成功地保持了低的无保险率,并改善了儿童保险覆盖.
- 该计划在招收单身成年人方面表现不那么有效,尽管最近的扩张可能会改变这一点.
- 明尼苏达州的经验为州和国家改革提供了一个模型,旨在减少无保险,特别是儿童的无保险.
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