1、本科毕业论文（设计）外文翻译外文题目NOCAREFORTHECAREGIVERSDECLININGHEALTHINSURANCECOVERAGEFORHEALTHCAREPERSONNELANDTHEIRCHILDREN,19881998外文出处PUBLICHEALTHUNITEDSTATES外文作者BRADYGSCASE,AB,DAVIDUHIMMELSTEIN,MD，ANDSTEFFIEWOOLHANDLER,MD,MPH原文NOCAREFORTHECAREGIVERSDECLININGHEALTHINSURANCECOVERAGEFORHEALTHCAREPERSONNELANDTHEI
2、RCHILDREN,19881998TWOYEARSAGO,MOREAMERICANSWEREUNINSUREDTHANATANYOTHERTIMEINTHEPREVIOUS2DECADES,YETTHEIMEMPLOYMENTRATEIN1999WASTHENATIONSLOWESTSINCE1969BECAUSEMOSTAMERICANSSECUREHEALTHINSURANCETHROUGHANEMPLOYER,ACCOUNTINGFORFLIISPARADOXHASBEENACENTRALTASKOFHEALTHPOLICYRESEARCHEXPLANATIONSHAVEFOCUSED
3、ONRISINGCOSTSOFCOVERAGE,ASWELLASONGROWINGSEIVICESECTORANDPARTTIMEEMPLOYMENT,DECLININGUNIONIZATION,SEGREGATIONOFHIGHANDLOWWAGEWORKERSINTODIFFERENTFIRMS,SHRINKINGJOBTENURE,ANDERRORINTLIEMEASUREMENTOFCOVERAGETHEROLEOFINSTITUTIONSOFCAREHOSPITALS,MEDICALOFFICES,NURSINGHOMES,ANDHOMECAREAGENCIESHASRECEIVED
4、LESSATTENTIONDESPITETHEHEALTHCAREINDUSTRYSDRAMATICGROWTHANDLONGSTANDINGIMPORTANCEASANEMPLOYERININNERCITY,RURAL,ANDMINORITYCOMMUNITIESWEEXAMINEDTRENDSINTHEHEALTHINSURANCECOVERAGEOFPERSONNELWORLDNGINHEALTHESTABLISHMENTSANDTHEIRCHILDRENOVERTHEPASTDECADEMETHODSWEANALYZEDDATAFROMTHEAIMUALMARCHSUPPLEMENTS
5、OFTHECURRENTPOPULATIONSUREYFOR1989THROUGH1999THECPSISANANNUALCENSUSBUREAUSURVEYOFANATIONALLYREPRESENTATIVESAMPLEOFAPPROXIMATELY150000NONINSTITUTIONALIZEDUSRESIDENTSINABOUT50000HOUSEHOLDSRESPONDENTSAREASKEDABOUTTHEIRINSURANCESTATUSDURINGTHEPREVIOUSCALENDARYEAR,ASWELLASOCCUPATIONALANDDEMOGI“APHICCHARA
6、CTERISTICSONEQUARTEROFTHERESPONDENTSAREASKEDABOUTLUIIONMEMBERSHIPWEUSEDSTANDARDINDUSTRIALCLASSIFICATIONCODESTOIDENTIFYPRINCIPALPLACEOFEMPLONNENTINTHEWEEKBEFORETHESURVEYPERSONSEMPLOYEDINTHEOFFICESOFPHYSICIANSOROTHERHEALTHPRACTITIONERS,INHOSPITALS,INNURSINGANDPERSONALCAREFACILITIES,ORINOTHERHEALTHSERV
7、ICESWEREDEFINEDASHEALTHPERSONNELNONHEALTHPERSONNELWEREPERSONSEMPLOYEDINOTHERSETTINGSPEOPLEWEREDEFINEDASPUBLICSECTOREMPLOYEESIFTHEYREPORTEDEMPLOYMENTBYFEDERAL,STATE,ORLOCALGOVERNMENTTHEYWEREDEFINEDASPRIVATESECTOREMPLOYEESIFTHEYREPORTEDWORKFORAPRIVATEEMPLOYERPERSONSOLDERTHAN65YEARSWEREEXCLUDEDFROMTHEA
8、NALYSISBECAUSEVIRTUAEYALLARECOVEREDBYMEDICARECHILDRENINHOUSEHOLDSOFHEALTHCAREPERSONNELWEREDEFINEDASPERSONSYOUNGERTHAN18YEARSWHOSHAREDLIVINGQUMTORSROOMS,ANAPARTMENT,ORAHOUSEWITHATLEAST1HEALTHCAREWORKERWECLASSITIEDOCCUPATIONSACCORDINGTOTHECENSUSBUREAUSOCCUPATIONALCLASSIFICATIONCODESFORDETAILEDOCCUPATI
9、ONALCATEGORIESPHYSICIANS,REGISTEREDNURSES,ANDLICENSEDPRACTICALNURSESWEREEACHIDENTIFIEDBYSINGLECODESCODES84,95,AND207,RESPECTIVELYOTHEROCCUPATIONSWEREGROUPEDASFOLLOWSMANAGERSANDMANAGEMENTRELATEDOCCUPATIONSAIDESFOODSERVICE,CLEANING,BUILDINGSERVICE,ANDLAUNDRYWORKERSCODES433444,448455,747,AND748CLERICAL
10、ANDADMINISTRATIVESUPPORTWORKERSCODES205,276,303,AND390ANDOTHERWORKERSALLOTHERCODESNEITHERSICNOROCCUPATIONALCLASSIFICATIONCODESIDENTIFYPUBLICHEALTHWORKERSPEOPLEWERECONSIDEREDINSUREDIFTHEYREPORTEDANYHEALTHINSURANCE,PUBLICORPRIVATEPOPULATIONESTIMATESWEREDERIVEDBYUSINGWEIGHTSSUPPLIEDBYTHECENSUSBUREAUTHE
11、SEWEIGHTSADJUSTFORTHECOMPLEXSAMPLEDESIGNANDTHEFAILURETOOBTAININTERVIEWSFROMSOMEHOUSEHOLDSWEIGHTSFORSURVEYDATAFORTHEMARCH1994ANNUALCPSANDTHEREAFTERWEREOBTAINEDFROMANUPDATEDSAMPLEFRAMEWORKBASEDONTHE1990DECENNIALCENSUSWEIGHTSFORDATAPRIORTOTHE1994CPSWEREBASEDONTHE1980CENSUSTHECHANGEHADLITTLEEFFECTONESTI
12、MATESOFTHEPERCENTAGEUNINSUREDBUTDIDALTERESTIMATESOFTHENUMBERIMINSURED“RESULTSBETWEEN1988AND1998,THENUMBEROFUNINSUREDHEALTHCAREPERSONNELINCREASED834,FROM74300090CI681000,806000TO136MILLION90CI128MILLION,145MILLION,ANDTHEPROPORTIONUNINSUREDROSEFROM8490CI78,91TO12290CI115,129TABLE1THENUMBEROFUNINSUREDW
13、ORKERSINOTHERINDUSTRIESGREWMOREMODESTLYOVERTHEPERIOD,UP378,WHEREASTHEPROPORTIONWHOWEREUNINSUREDINCREASEDFIXM14790CI145,150TO17990CI177,182COVERAGEOFHEALTHCAREWORKERSVARIEDBYPLACEOFEMPLOYMENTTWENTYPERCENT90CI179,221OFNURSINGHOMEPERSONNELWERELUIINSUREDIN1998,COMPAREDWITH820/B90CI73,90OFHOSPITALWORKERS
14、,8790CI70,104OFTHOSEEMPLOYEDINMEDICALOFFICES,AND15990CI143,174OFWORKERSATOTHERHEALTHCAREESTABLISHMENTSTHEPRIVATESECTORACCOUNTEDFORALLOFTHEGROWTHINTHENUMBEROFUNINSUNEDHEALTHPERSONNELTHENUMBEROFUNINSUREDPERSONNELINPRIVATEINSTITUTIONSROSEBY61400090CI517000,712000A1014INWEASEBETWEEN1988AND1998THERELATIV
15、EGROWTHOFPRIVATEHEALTIICAIEEMPLO5MENT384COMPAREDWITHA196DECLINEINPUBLICEMPLOYMENTCONTRIBUTEDTOTHISLARGEINCREASEHOWEVER,ARISEINTHEPROPOITIONOFPRIVATESECTORHEALTHWORKEREUNINSUREDFROM8690CI78,93TO12590CI117,133ACCOUNTEDFORMOSTOFTHEINCREASEINTHENUMBEROFLUMISUREDPRIVATESECTORHEALTHPERSORMELTHEPROPORTIONO
16、FALLPUBLICSECTORHEALTHPERSONNELWHOWEREUNINSUIEDREMAINEDSTABLE,AT7690CI59,92IN1988AND7890CI59,96O/OIN1998WORKERSINPUBLICHOSPITALSANDNURSINGHOMESWEREMUCHLESSLIKELYTOBEUNINSUREDTHANWEREWORKERSINCOMPARABLEPRIVATEINSTITUTIONSIN1998UNINSURANCEREMAINEDSTEADYAT6590CI46,83IN1988AND6390CI41,84IN1998AMONGPUBLI
17、CHOSPITALWORKERS,BUTITROSEFROM5490CI45,63TO8590CI75,94INPRIVATEHOSPITALSOFTHEPUBLICNUISINGHOMEWORKERS,7590CI23,126WEREUNINSUREDIN1998,DOWNFROM11990CI57,18110YEARSEARLIER,WHEREASINPRIVATENURSINGHOMES,THEPROPORTIONUNINSUREDGREWTO20990CI187,232FROM18890CI163,213TOTALEMPLOYMENTATPUBLICHOSPITALSALSODECLI
18、NEDSUBSTANTIALLYBY304BUTINCREASEDATPRIVATEHOSPITALSAMONGOCCUPATIONALGROUPS,AIDESHADTHEHIGHESTUNINSMANCERATEIN199823890CI217,259ANDACCOUNTEDFOR370OFTHEUNINSUREDHEALTHPERSORMELFOODSERVICE,CLEANING,BUILDINGSERVICE,ANDLAUNDRYWORKERSALSOHADRELATIVELYLOWRATESOFHEALTHCOVERAGE19790CI117,277WEREUNINSUREDIN19
19、98THEPROPORTIONOFUNINSUREDLICENSEDPRACTICALNURSESROSESTEEPLYBETWEEN1988AND1998,FROM7390CI42,103TO14590CI103,187,ANDUNINSURANCEAMONGPHYSICIANSINCREASEDFROM3390CI15,52TO5490CI33,76PEREONNELINMANAGEMENTRELATEDOCCUPATIONSSAWTHESHARPESTFALLINCOVERAGE,FROM2890CI140/0,42UIUNSUREDIN1988TO7390CI55,91IN1998,A
20、NDEXPERIENCEDA28290CI104,460INCREASEINTHENUMBERUNINSUREDUNIONIZEDWORKERSHADAHIGHERRATEOFINSURANCETHANDIDNONUNIONIZEDHEALTHWORKERSINBOTHYEARSANDEXPERIENCEDAMILDERDEDINEINCOVERAGEIN1988,6390CI45,81OFTHEUNIONMEMBERSEMPLOYEDINHEALTHCARESETTINGSWEREUNINSURED,COMPAREDWITH8890CI81,96OFTHENONUNIONWORKEREBY1
21、998,THEPROPOITIONOFUNIONMEMBERSUNINSUREDHADRISENTO7890CI60,97,WHEREASAMONGNONUNIONHEALTHWORKERS,13390CI126,141WEREUNINSUREDUNIONIZATIONRATESAMONGHEALTHPERSONNELDECREASEDFROM10990CI98,113KI1988TO9790CI90,103IN1998IN1998,20590CI178,231OFBLACKHEALTHCAREWORKERSWEREUNINSURED,COMPAREDWITH10490CI97,112OFWH
22、ITEHEALTHPERSONNELTABLE2BLADWOMEN,WHOCONSTITUTED129OFTHEHEALTHCAREWORKFORCEIN1998,ACCOUNTEDFOR225OFTHEUNINSUREDPERSONNELHISPANICWORKERSWHOMAYBEOFANYRACEWERETWICEASLIKELYASNONHISPANICSTOBEUNINSURED24790CI206,287VS11290CI105,119HOWEVER,INSURANCECOVERAGEWASDIMINISHEDFORVIRTUALLYEVERYHEALTHOCCUPATIONINE
23、VERYTYPEOFINSTITUTION,SUGGESTINGAWIDESPREADDETERIORATIONIIITHEQUALITYOFHEALTHCAREJOBSAFRICANAMERICANWOMEN,WHOTRADITIONALLYHAVESOUGHTWORKINHEALTHCARE,MAYBEPARTICULARLYVULNERABLETOTHESECHANGES192OFWORKINGAFRICANAMERICANWOMENWEREEMPLOYEDBYTHEHEALTHCARESECTORIN1993WEBELIEVETHATTHEINCREASINGRELIANCEONMAR
24、KETFORCESINMEDIDNEHASERODEDTLIEQUALITYOFHEALTHCAREJOBSINPURSUITOFMINIMALLABORCOSTS,MARKETMEDICINEDENIESHEALTHBENEFITSTOHEALTHWORKERSANDTHEIRCHILDRENJTHEPROFITSACCRUINGTOCHIEFEXECUTIVEOFFICERSANDSHAREHOLDERSMIGHTBEVIEWEDASATIANSFEROFCOMPENSATIONTOTHEMFIROMTHEIRWORKERSAFEWCAVEATSAREDUEFIRST,WELINKEDCH
25、ILDRENTOHEALTHWORKERSONTHEBASISOFSHAREDLIVINGQUARTERSBECAUSELOWINCOMEFAMILIESMAYBEFORCEDTO“DOUBLEUP“INHOUSING,SOMEUNINSUREDCHILDRENMAYBELIVINGINHOUSEHOLDSWITHAHEALTHCAREWORKERWHOHASNOPARENTALORFINANCIALRESPONSIBILITIESFORTHEMCONVERSELY,UNINSUREDCHILDRENRESIDINGSEPARATELYFROMAHEALTHCAREWORKERPARENTWO
26、ULDBEMISSEDBYOURTABULATIONSOVERALL,WESUSPECTTHATTHEMAGNITUDEOFTHESEERRORSISNOTLARGESECOND,FINDINGSOFDIFFERENCESOFFEWERTHAN70000PERSONSMAYBEDUETOCPSSAMPLINGERRORANDSHOULDNOTBECONSIDEREDSIGNIFICANTTHIRD,SOMEWORKERSMAYHAVEBEENOFFEREDHEALTHINSURANCEBUTDECLINEDITPRESUMABLY,THEUSUALREASONANUNINSUREDWORKER
27、DEDINESEMPLOYERSPONSOREDINSURANCEISTHESAMEINHEALTHCAREASINOTHERINDUSTRIESUNACCEPTABLELEVELSOFCOSTSHARING“FINALLY,SOMEUNINSUREDHEALTHPERSONNELMAYHAVEACCESSTOINFORMAL,LOWCOSTCAREFROMCOLLEAGUESTHESEPERSONNELMAYBEABLETOAVOIDSOMEHEALTHHAZARDSFACEDBYOTHERUNINSUREDPERSONS,BUTSUCHUNPAIDCAREISUNLIKELYEITHERT
28、OENCOMPASSCOSTLYTHERAPIESORPREVENTIVESERVICESORTOBEREADILYAVAILABLETOMOSTLOWSTATUSHEALTHPERSONNELHEALTHCAREINSTITUTIONSESCALATINGDEPENDENCEONUNINSUREDWORKERSRAISESTROUBUNGQUESTIONSABOUTMEDICALQUALITYANDETHICSCANANUNINSUREDHEALTHAIDEWITHLIMITEDACCESSTOCAREFORBACKPAIN,SEIZURES,ORCOUGHSAFELYLIFTANDFEED
29、FRAILPATIENTSCANAWOMANWITHOUTACCESSTOFAMILYPLANNINGSERVICESETHICALLYBETOLDTOCAREFORPERSONSWITHCJRTOMEGALOVIRUSORKSTEDOSISORTHOSETAKINGHIGHDOSERADIOPHARMACEUTICALSANDCANTHOSEDENIEDHEALTHCOVERAGEANDCAREFORTHEMSELVESANDTHEII“CHILDRENBEEXPECTEDTOCARECOMPASSIONATELYFORSTRANGERSUNINSUREDADULTSANDUNINSURED
30、USCHILDRENAREMORELIKELYTOBEINADEQUATELYIMMUNIZED,TOLACKAUSUALSOURCEOFCAREORPHYSICIAN,ANDTOHAVEUNMETMEDICALNEEDSTHANTHEIRPRIVATELYINSUREDCOUNTERPARTSINDENYINGCARETOCAREGIVERS,OURINCREASINGLYMARKETDRIVENHEALTHCARESYSTEMSUBVERTSANINTUITIVEANDUNIVEREALETHICALINSTRUCTIONDOUNTOEACHASYOUWOULDHAVEDONEUNTOYO
31、UPUBLICHEALTHUNITEDSTATES译文不要为明天忧虑,因为照护者健康状况每况愈下保险费用的卫生保健人员和他们的子孙,19881998两年前,更多的美国人没有任何保险的任何时候都要有意志力。在过去的二十年来,但在1999年失业率是1969年以来最低水平。因为大多数美国人安全的医疗保险计划的雇主,悖论的中心任务是健康政策研究。主要集中在需要解释的险种,成本的上升以及服务的增长和兼职工作的下降,低工资使得工人数量萎缩,在不同的公司工作的任期内,外国的错误标准的作用使很多机构、医疗机构、疗养院、及家居护理灯很少受到注意。尽管卫生行业的巨大发展速度、源远流长的重要性,雇主城市中心、农村、
32、少数民等等。我们检查趋势人员的健康保险和健康设施和他们的孩子在过去的十年。方法我们分析了3月数据来补充现行的人口领事。核实一年一度的调查结果显示,人口普查局的一组具有全国代表性的大约150万美国居民，约50000人组成的核心家庭。被问及他们自己的保险状况在过去一年,以及职业和特点。我们使用的标准工业分类的规定确定的主要场所来调查。在办公室里从业人员的医生或其他健康专业人员在医院,在护理及个人护理设施,或以其他的健康服务医疗卫生工作人员。从业人员包括其他设置。人被定义为员工如果报告就业的联邦、州或地方政府他们定义为私营部门的员工如果他们报道的私人雇主工作。年龄超过65岁的人被排除在分析覆盖的都是
33、由于医疗保险。家庭中孩子的健康保健人员被确定为18岁以下的人分享生活工具房间,一所公寓,或房屋至少有1类保健工作者。我们划分职业，根据人口统计局的职业分类代码的详细职业类别。医师、注册护士、许可、实践护士是每个识别出的由单个的代码。分组其他职业职业分类代码识别公共卫生工作者。被保险人如果他们报道任何健康保险,公共或私人。这些权值调整为复杂的样本设计和疏忽获得面试从一些家庭。调查数据的权重。此后,1994年3月每年更新得出了样品框架基于1990年的人口普查。重量数据在1994年是基于这一变化是1980年的人口普查影响极小百分比的估计,但是却没有改变的估计数量。”结果在1988年到1998年间,没
34、有保险的卫生保健人员的数量增加了834万,从业人员681万,8060万人，资金到136亿元128亿美元。和比例的没有保险的上升84没有保险的工人的数量在其他行业的更为谨慎地增长,在一段时间内378,而没有任何保险比例已经增加到147179。不同的工人的卫生保健方面的报道办公地点20,护理之家的人员，在1998年,与82的医务人员,87医疗机构工作,占159的工人在其他卫生保健设施。私营企业占所有的越来越多的卫生人员没有保险的人员的数量增长了私人机构在1988年到1998年。相对增长的私人成分吗和之前相比,在公共领域下降到196。然而,提高私营的健康增长93至125占133对于大多数种群数量的增
35、长私营健康。公共部门的比率,健康人员ED保持稳定,在76于1988年与78于1998年。工人对公立医院和护理之家的可能性更小工人是没有保险的比同类私人机构于1998年。保持稳定为65901988年和6341,1998年,83成为公共医务人员,但它上升至54照相私家医院。公共家里种群工人,75没有任何保险在1998年,下来10年前,而在私立疗养院,比例没有保险的长了163,213。总就业人数在公立医院也下降了提高私家医院。在职业团体、助手了率最高217,而且已入账没有保险的药物阻断性健康。餐饮服务、清洁、建设服务,和洗衣的人员也有了较低的利率的健康。没有任何保险,在1998年。没有保险的比例急剧
36、上升许可实践护士在1988年到1998年,从增加在医生3354。在职业看到最大跌幅,从报道28,1988年到73于1998年,经历了282增加在数量上的没有保险。工会的工人有较高的增长率保险卫生工作者比在两年内DEDINE温和,积累丰富经验在报道。1988年,63用于工会成员再造健康护理环境中没有任何保险。到1998年为止,工会成员的没有保险的上升到,而在不愈合,卫生技术人员占133没有任何保险。校方医疗卫生工作人员的发生率下降至109的吻1988年至97于1998年。1998年,205术前即黑色的卫生保健工作者没有任何保险,与104的白色卫生人员表2。那设立129医疗劳动力在1998年,占2
37、25最最没有保险的人员。西班牙可为任何的两倍是没有保险的病症。然而,保险就消失了,几乎每个健康职业。各种类型的机构,暗示了广泛的质量恶化的健康护理工作。非洲裔的美国妇女,那些传统上在医疗保健,寻找工作特别容易受到这些工作,非洲裔的美国妇女受雇于保健行业的。我们相信越来越依靠市场在外国的侵蚀质量的卫生保健工作。追求最低限度的劳动成本、市场药否认健康有益健康工人和他们的小孩。于利润主管和股东可能会被看作是对他们的补偿他们的工人。首先,把我们联系在一起的孩子医护人员共享的基础上的生活区。因为低收入家庭可能会被迫“双”在住房、一些没有保险的儿童可能住在保健工作者的家庭用户没有家长或财务责任。相反地,居
38、住分别从一个保健工作者的家长都很想念我们的表格。总的来说,我们怀疑这些错误的大小并不是很庞大。第二,发现不同的少于7万多名的人可能是由于抽样误差核而且也不应该被认为是重要的第三,一些工人可能已经得到了健康保险但谢绝了。据推测,通常的原因没有保险的职工保险是一样的卫生保健和其他水平的成本分担。“最后,一些没有保险的卫生人员可以查阅、隔间非正式的人文关怀的同事们。这些工作人员可以避免一些面临的健康危害没有保险的人是不可能的,但护理的内涵昂贵的治疗或或预防服务或者最会随叫随到那个健康人员。卫生保健机构的升级依赖问题没有保险的工人提高医疗质量和道德规范。一个没有保险的健康助理有限的享受医疗服务的背部疼痛,癫痫发作,或咳嗽升力和饲料虚弱病人安全吗妇人没有获得计划生育服务伦理上被命令去关心的人,或或服用大剂量吗并能那些否认健康保险和关心自己和孩子们预期照顾陌生人妥善处理保单我们没有保险的成年人和没有保险的孩子更有可能不足,缺乏免疫的来源通常关心或医生,并有医疗需求无法满足他们的个人医疗保险的同行。否定,我们愿意照顾者的重要保障以市场为导向的卫生保健系统的一种直觉的话,诚信而立对每一个你们愿意的人，我们会给你们成就。布拉迪，大卫美国美国公共卫生杂志上MAR92卷,第3期,
