摘要：Objectives . This study examined trends in health insurance coverage for health care workers and their children between 1988 and 1998. Methods . We analyzed data from the annual March supplements of the Current Population Survey (CPS), a Census Bureau survey that collects information about health insurance from a nationally representative sample of noninstitutionalized US residents. Results . Of the health care personnel younger than 65 years, 1.36 million (90% confidence interval [CI] = 1.28 million, 1.45 million) were uninsured in 1998, up 83.4% from 1988; the proportion uninsured rose from 8.4% (90% CI = 7.8%, 9.1%) to 12.2% (90% CI = 11.5%, 12.9%). Declining coverage rates in the growing private-sector health care workforce—and declining health employment in the public sector, which provided health insurance benefits to more of its workers—accounted for the increases. Households with a health care worker included 1.12 million (90% CI = 1.05 million, 1.20 million) uninsured children, accounting for 10.1% (90% CI = 9.5%, 10.8%) of all uninsured children in the United States. Conclusions . Health care personnel are losing health insurance coverage more rapidly than are other workers. Increasingly, the health care sector is consigning its own workers and their children to the ranks of the uninsured. Two years ago, more Americans were uninsured than at any other time in the previous 2 decades, yet the unemployment rate in 1999 was the nation's lowest since 1969. 1, 2 Because most Americans secure health insurance through an employer, accounting for this paradox has been a central task of health policy research. Explanations have focused on rising costs of coverage, 3– 5 as well as on growing service-sector and part-time employment, 6, 7 declining unionization, 8 segregation of high- and low-wage workers into different firms, 9 shrinking job tenure, 10 and error in the measurement of coverage. 11, 12 The role of institutions of care—hospitals, medical offices, nursing homes, and home care agencies—has received less attention despite the health care industry's dramatic growth and long-standing importance as an employer in inner-city, rural, and minority communities. 13– 15 We examined trends in the health insurance coverage of personnel working in health establishments and their children over the past decade.
