Reviewing a Decade of Progress in Health Insurance and Access to Care for Adolescents: How Have Historically Underserved Youth Fared?
Abstract
Research Objective: To examine changes in rates of uninsurance and access to care among adolescents ages 12-17 and assess whether trends over time differed by socio-demographic group.
Study Design: This study used data from the National Health Interview Survey (NHIS) from 2007-2016. Multivariate logistic regression and post-estimation marginal effects were used to assess changes in three outcomes: (1) currently uninsured; (2) well visit in past year; and (3) delayed medical care in past year due to cost.
Principal Findings: Across all 12-17 year-olds, the uninsured rate dropped from 10.2% to 6.0%; annual well visits increased from 67.3% to 80.2%; and delayed care decreased from 4.2% to 2.8%. The uninsured rate increased for non-citizens compared to a significant decline for citizens. Older youth and those in Spanish-speaking households experienced slower growth in well visit rates over time compared to their counterparts. Near-poor adolescents insured by Medicaid/CHIP experienced greater improvements in delayed care for cost, while those in Spanish-speaking households lost ground.
Conclusions: This study is the first to focus specifically on how insurance and access gains have been realized in the adolescent population as a whole and throughout various demographic. Our results indicate that nearly all adolescents experienced improvements in both insurance and access to care over a decade; however, policy initiatives that focus specifically on older youth, non-citizens, Hispanics, and those in Spanish-speaking households should be examined as these groups of adolescents seemed were often left behind.
Key words: adolescents, health insurance, access to care, well visit, cost of care, disparities, CHIP, ACA
Reviewing a Decade of Progress in Health Insurance and Access to Care for Adolescents: How Have Historically Underserved Youth Fared?
Research Objective: To examine changes in rates of uninsurance and access to care among adolescents ages 12-17 and assess whether trends over time differed by socio-demographic group.
Study Design: This study used data from the National Health Interview Survey (NHIS) from 2007-2016. Multivariate logistic regression and post-estimation marginal effects were used to assess changes in three outcomes: (1) currently uninsured; (2) well visit in past year; and (3) delayed medical care in past year due to cost.
Principal Findings: Across all 12-17 year-olds, the uninsured rate dropped from 10.2% to 6.0%; annual well visits increased from 67.3% to 80.2%; and delayed care decreased from 4.2% to 2.8%. The uninsured rate increased for non-citizens compared to a significant decline for citizens. Older youth and those in Spanish-speaking households experienced slower growth in well visit rates over time compared to their counterparts. Near-poor adolescents insured by Medicaid/CHIP experienced greater improvements in delayed care for cost, while those in Spanish-speaking households lost ground.
Conclusions: This study is the first to focus specifically on how insurance and access gains have been realized in the adolescent population as a whole and throughout various demographic. Our results indicate that nearly all adolescents experienced improvements in both insurance and access to care over a decade; however, policy initiatives that focus specifically on older youth, non-citizens, Hispanics, and those in Spanish-speaking households should be examined as these groups of adolescents seemed were often left behind.
Key words: adolescents, health insurance, access to care, well visit, cost of care, disparities, CHIP, ACA