The role of Medicaid in ensuring children's access to care

被引:85
作者
Newacheck, PW
Pearl, M
Hughes, DC
Halfon, N
机构
[1] Univ Calif San Francisco, Sch Med, Inst Hlth Policy Studies, San Francisco, CA 94109 USA
[2] Univ Calif San Francisco, Sch Med, Dept Pediat, San Francisco, CA 94109 USA
[3] Univ Calif Los Angeles, Sch Med, Dept Pediat, Los Angeles, CA 90024 USA
[4] Univ Calif Los Angeles, Sch Publ Hlth, Los Angeles, CA 90024 USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 1998年 / 280卷 / 20期
关键词
D O I
10.1001/jama.280.20.1789
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context.-Congress enacted a series of laws beginning in the mid 1980s to expand Medicaid eligibility for children, especially those in poor families. As a result, Medicaid enrollment of children has nearly doubled over the past decade. Objective.-To assess the effectiveness of Medicaid in improving access to and use of health services by poor children. Design-Analysis of cross-sectional survey data from the 1995 National Health Interview Survey. Poor children with Medicaid were compared to poor children without insurance and nonpoor children with private insurance. Setting and Participants.-A total of 29711 children younger than 18 years (3716 poor children with Medicaid, 1329 poor children without insurance, 14 609 nonpoor children with private insurance, and 10 057 children with other combinations of poverty and insurance status) included in a nationally representative stratified probability sample of the US noninstitutionalized population. Main Outcome Measures.-Usual source of care, access to a regular clinician, unmet health needs, and use of physician services. Results.-Poor children with Medicaid compared to poor children without health insurance experienced superior access across all measured dimensions of health care, including presence of a usual source of care (95.6% vs 73.8%), frequency of unmet health needs (2.1% vs 5.9%), and use of medical services (eg, greater than or equal to 1 physician contact in past year) (83.9% vs 60.7%). Poor children with Medicaid compared to nonpoor children with private insurance used similar levels of physician services (83.9% vs 84%), but were more likely to have unmet health needs (2.1% vs 0.6%) and were less likely to have a usual source of care (95.6% vs 97.4%). Conclusion.-Medicaid is associated with improvements in access to care and use of services. However, there remains room for improvement when Medicaid is judged against private health insurance. The Balanced Budget Act of 1997 contains several Medicaid provisions that could stimulate further improvements in access for poor children.
引用
收藏
页码:1789 / 1793
页数:5
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