凯撒调查：许多女性跳过了预防保健服务

华盛顿——凯撒家庭基金会在2013年的9月到11月之间使用英语及西班牙语对大约3000名15～64岁的女性进行了一项电话调查，该调查刚刚发布研究结果显示，低收入女性（个人保险或医疗补助）常跳过预防保健服务及未采取任何避孕措施，除了开销顾虑外，主要原因在于她们并不熟悉《平价医疗法案》（ACA）的现有政策。

凯撒家庭基金会副总裁兼其妇女健康政策办公室主任Aline Salganicoff在发布会上说，本次调查能够“拿到基线数据，而了解现状非常重要”，并以此作为未来对比的基础，为更多的女性提供保障和福利。

该调查启动时，已经有许多预防保健政策自2012年开始对大多数女性适用。在ACA支持下， 2010年已经起效的修订版健康计划被要求覆盖包括乳房X光检查、子宫颈抹片检查、家庭暴力咨询、性传播疾病（STIs）和避孕在内的服务。医疗补助也覆盖了预防性服务内容。

在女性中的调查发现，51%的女性拥有雇主提供的保险，9%的女性得到医疗补助，7%购买了个人保险，6%享受父母健康保险政策，另外6%则享受政府的其他保险项目，还有18%未参保。按收入分层后发现，在2倍贫困线下的女性有40%未参保，21%只享受医疗补助。

26%的受访女性解释去年推迟参保是因为成本的增加，大约20%的女性则直接跳过了推荐的检查或治疗，甚至没有填写处方。28%的女性则无法负担他们的医疗费用。这些数据均高于凯撒调查同期进行的男性样本数据。

而关于预防保健服务，60%的女性承认她们知道保险机构每年都会提供至少一项免费预防保健服务项目，以及少量共付或免赔及其他费用的预防保健项目。

购买个人保险的女性中有88%近期均有进行体检，享受医疗补助的妇女中则有81%近期接受了体检。而未参保的女性近期体检的比例仅为60%，只有大约40%的女性则报告她们与健康服务人员讨论了精神问题。ACA法案中虽然规定了相应的精神健康服务，但其并未明确确切的覆盖范围。在所覆盖的筛查项目中，接受高血压筛查的比率最高（92%），结肠镜检查的比率最低。

73%的女性报告她们的保健服务来源于医生及健康维持组织（HMO）；13%在诊所接受保健服务，但有3%的女性则报告她们通常在急诊室接受保健服务。

临床医师对拥有不同保险和不同种族的女性的随访有所区别。对于享受医疗补助的女性、黑人女性和西班牙裔女性来说，医师们更关注她们的性生活、HIV和STIs情况。

撒家庭基金会妇女健康政策办公室副主任Usha Ranji认为，如果假定STI检测为妇产科门诊的常规检查项目，那么大概只有40%的女性接受了检查，但实际上这个比例应该更低。

另外，即便所有的健康计划均覆盖了避孕服务，仍有20%受访女性称其未采用任何避孕措施。而在那些使用避孕措施的女性中，一半以上报告避孕服务全部或部分可被覆盖。

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调查显示：69%的受访者支持ACA的避孕法令

http://www.elseviermed.cn/news/detail/69_support_ACA_contraceptive_mandate

 

By: ALICIA AULT, Ob.Gyn. News Digital Network

WASHINGTON – A just-released survey conducted last fall shows that low-income women with private insurance or Medicaid were often foregoing preventive care and use of contraceptives, in part due to cost, but also because of a lack of awareness of benefits that were already available under the Affordable Care Act.

The Kaiser Family Foundation conducted the survey of some 3,000 women aged 15-64 years by telephone – in English and Spanish – from September to November 2013. The goal was to get a baseline picture of women’s health care before the ACA was fully implemented in January.

"It’s important to know where we are today, to have a baseline" with which to compare outcomes in the future, after more women have insurance and broader access to benefits, Aline Salganicoff, vice president and director of women’s health policy for the Kaiser Family Foundation, said at a briefing.

At the time of the survey, many preventive benefits had already been available to a large number of women since 2012. Under the ACA, health plans that had changed since the law went into effect in 2010 were required to cover services such as mammograms, Pap smears, counseling on domestic and interpersonal violence and sexually transmitted infections (STIs), and contraception. Medicaid also has been covering those preventive benefits.

Among the women surveyed, 51% had employer-provided insurance, 9% were on Medicaid, 7% had individual coverage, 6% were on a parent’s policy, 6% were covered by another government program, and 18% were uninsured. When stratified by income, women who were under 200% of the poverty line were more likely to be uninsured (40%) or on Medicaid (21%).

More than a quarter overall (26%) said they’d delayed care in the past year because of cost, and about 20% said they had skipped recommended tests or treatments, or not filled prescriptions. Twenty-eight percent said they had trouble paying medical bills. All of these rates are higher than in a comparable sample of men surveyed by Kaiser.

When it came to knowledge about preventive services, 60% said they knew insurers were required to cover the cost of at least one preventive visit a year with no out-of-pocket costs, and a slightly smaller number were aware that the plans were also required to provide preventive services free of copays, deductibles, or other charges.

About 88% of women with private insurance said they’d had a recent checkup with a doctor, compared with 81% of those with Medicaid. Not surprisingly, fewer uninsured women had a recent checkup – only about 60%. Only about 40% of women said they’d talked with a health provider about a mental health issue. Mental health services are considered an essential benefit under the ACA, but it’s not clear yet what exactly will be covered.

Most women (73%) reported that their usual source of care was a doctor or an HMO; 13% received care in a clinic, but 3% reported the emergency room as their usual source of care.

For screening tests that are covered, rates of use were high for hypertension (92%) but extremely low for colonoscopy – only 39% of all women reported having had the exam at the appropriate interval, with rates dipping to 35% for blacks and 34% for Hispanics.

Women with private insurance were more likely to have visited an ob.gyn. in the past year – at about 70%, compared with 58% of those on Medicaid, and 43% of the uninsured.

Physician counseling varied by insurance status and ethnicity. Clinicians were more likely to discuss sexual history, HIV, and STIs with women on Medicaid, and black and Hispanic women. Of women on Medicaid, 52% said their provider had talked about HIV, compared with only 29% of those with private insurance. The uninsured had the lowest rate of counseling on any of those topics.

Only about 40% of women were tested for an STI, and among those women, half assumed that the test was a routine part of an ob.gyn. exam. It is not, so rates of testing are probably even lower than those being reported by the survey respondents, said Usha Ranji, associate director for women’s health policy at Kaiser, who was also an author of the survey.

Even though contraceptives are required to be covered by most health plans, 20% of those surveyed said they were not using any contraception. In part, that may be because condoms were reported as the primary method for all women, but especially for those under age 25, and for black women. Condoms are not reimbursed by any plan.

Among women who did use contraception, 32% said it was fully covered by insurance, 31% said it was partially covered, 10% said it was covered by Medicaid, and 18% said they did not have coverage.

The survey was conducted among a nationally representative random digit dial telephone sample, and a shorter companion survey with a nationally representative sample of 700 men aged 18-64 years was conducted at the same time. The margin of sampling error was plus or minus 3 percentage points for the full sample of women and plus or minus 4 percentage points for men.