摘要：Objectives . This study evaluated the relationships between health insurance and welfare status and the health and medical care of children with asthma. Methods . Parents of children with asthma aged 2 to 12 years were interviewed at 6 urban clinical sites and 2 welfare offices. Results . Children whose families had applied for but were denied welfare had more asthma symptoms than did children whose families had had no contact with the welfare system. Poorer mental health in parents was associated with more asthma symptoms and higher rates of health care use in their children. Parents of uninsured and transiently insured children identified more barriers to health care than did parents whose children were insured. Conclusions . Children whose families have applied for welfare and children who are uninsured are at high risk medically and may require additional services to improve health outcomes. Asthma, the most common chronic illness of childhood, affects approximately 6% of US children. Rates of emergency department and outpatient visits for asthma have increased since 1995, whereas rates of hospitalization and death have decreased. 1 Minority children and children from low-income and singleparent families have higher rates of disability due to asthma than do other children. 2 Urban children living in poverty have more exposure to environmental asthma “triggers” and to complex family and social situations. Previous studies have shown that children with Medicaid insurance receive less optimal medical care and use emergency care services more frequently than do other children. 3 The burden of caring for a chronically ill child is particularly great for families living in poverty. Since the passage of the Personal Responsibility and Work Opportunity Reconciliation Act in 1996, welfare rolls have declined rapidly. Many women who leave welfare also lose health insurance for themselves and their children and enter jobs that do not provide health insurance. 4 Temporary Assistance for Needy Families (TANF) and Medicaid are now administered as separate programs; many children remain eligible for Medicaid after their families leave TANF. However, recent large declines in Medicaid enrollment among TANF recipients have not been accompanied by equally large increases in Medicaid enrollment among non-TANF recipients. 5 TANF recipients are poorer, less educated, and less healthy in comparison with poor mothers who have never received welfare, and they have higher rates of depression. 6 We hypothesized that chronically ill children of welfare recipients would have poorer health outcomes than similar children of nonrecipients and that children who are uninsured or transiently insured would have poorer health outcomes than those who are insured continuously. The purpose of this study was to evaluate the relationships between health insurance status and welfare status and the health and medical care of children with asthma.
