标题：The Relationship of Health Insurance to the Diagnosis and Management of Asthma and Respiratory Problems in Children in a Predominantly Hispanic Urban Community
摘要：Objectives. As part of an asthma screening study, we evaluated the relationship of health care insurance coverage to the diagnosis and treatment of elementary school children for asthma and related respiratory problems from 1998 through 2001. Methods. A bilingual questionnaire assessing health care coverage, asthma diagnosis, respiratory symptoms, and use of medications was distributed to parents of 6235 public and private school children in grades 2 through 5 in Passaic, NJ. Results. Responses for 4380 children (70%) revealed disparities in health care coverage and asthma diagnosis among racial and ethnic groups. Mexican and Dominican children had significant increases in health care coverage over the 4 years. Conclusions. The percentage of children with health insurance grew from 67% in 1998 to 81% in 2001, and the increase was related to NJ KidCare. Diagnosis of asthma and treatment were related to health care coverage. From 1998 through 2001, the Passaic Asthma Reduction Effort screened elementary school children for asthma and related respiratory problems. This program, funded by the Robert Wood Johnson Foundation and led by Passaic Beth Israel Hospital, was a communitywide activity involving all public, private, and religious schools in the city. This extensive screening program was prompted by increased school absenteeism owing to asthma and respiratory illnesses and asthma crises among children who had previously not been identified as having asthma. Passaic is an older industrial community in northern New Jersey. The city is undergoing a transition in demographics with a substantial in-migration of a variety of Hispanic populations. The largest of these groups are made up of ethnic Dominicans, Puerto Ricans, and Mexicans, many of whom are poor but ineligible for Medicaid. In the mid-1990s, concerns were raised about increasing numbers of children without health insurance. Identification of the number of children without health insurance and ineligible for Medicaid led to development of additional state-run children’s health insurance programs. 1, 2 In New Jersey, NJ KidCare evolved in collaboration with state- and federally funded health maintenance organization (HMO) programs to target these populations. Coverage was signed into law in July 1999. 3 As of December 30, 2001, evaluation of the HMO and NJ KidCare programs in Passaic County found that programs only reached 75% of eligible individuals. 4 As part of the Passaic Asthma Reduction Effort, a questionnaire was distributed to the parents of children in grades 2 through 5. The questionnaire was written in both Spanish and English and covered respiratory symptoms, environmental health factors considered to be asthma triggers, asthma diagnosis, use of respiratory medications, and health insurance and sources of health care. The choice of symptoms and environmental factors used in the questionnaire was based on previous instruments. 5– 12
