ADOLESCENT HEALTH: Access to Care Lagged in Early 1990s
One in seven children aged 10 to 18 lacked health insurance in 1995, which is nearly the same proportion that lacked coverage in 1984, even though government-funded programs now cover more children and teens, according to a study published in the August Pediatrics. Drs. Paul Newacheck and Charles Irwin of the University of California-San Francisco examined data collected on approximately 14,250 adolescents from the Census Bureau's 1995 National Health Interview Survey of more than 40,000 households. "Little progress has been made over the past fifteen years in reducing the numbers of uninsured adolescents," Newacheck said, pointing to the 14.1%, or 4.2 million adolescents, who lacked health insurance in 1995. Uninsured teens are twice as likely as their insured counterparts to skip doctors visits for more than one year, the authors said, noting that such teens miss out on preventive screenings and the opportunity to have their doctor talk with them about sexual choices and risky behaviors. In addition, uninsured teens are five times more likely to not have a routine doctor or clinic, four times more likely to have unmet health needs and three times more likely to visit the emergency room when they need a doctor, which is "the red flag that tells us this group is not getting the care they need," Irwin said. The authors found that coverage was not evenly distributed in the adolescent population, as 80% of uninsured adolescents came from families earning less than 200% of the federal poverty level. Hispanic and African-American teens were the least likely to have coverage, as were teens in the Southern and Western states.
The authors also point to a shift in insurance coverage, although not one that gave more teens health coverage. In 1984, more than three-quarters of adolescents were covered by private insurance, 11.9% relied on public coverage and 2% had a combination of both. By 1995, 71.2% of adolescents had private health insurance and 16.9% relied on public insurance, due in part to Medicaid expansions. However, in 1995, as in 1984, 14.1% of children were without coverage. "You would expect some improvement, but there has been no change in 10 years," Irwin said (UCSF release, 8/2).