ADOLESCENTS' PERCEIVED ACCESS TO HEALTH CARE. † 20

Abstract

OBJECTIVE: Adolescents face financial and non-financial barriers to use of health care. This study assesses whether adolescents: 1) are able to use their own health insurance, and 2) perceive availability of or use confidential care. DESIGN: We approached adolescents in 6 shopping malls in upstate NY while recruiting 18 and 19 year olds for a study of health services use. Ability to use insurance was measured by whether or not an adolescents had their own health insurance card. RESULTS: More than half (53%) of 486 11 to 21 year old adolescents reported having their own health insurance card. The proportion of adolescents with their own insurance card did not vary by age, gender, ethnicity, or site of recruitment. Of 110 eligible 18 and 19 year olds, 80 (72%) enrolled in the survey and 57 (71%) completed telephone interviews. Nearly half (44%) were female, 26% were non-white, and 93% reported good or excellent health status. Most (91%) adolescents reported having a regular source of health care, and 84% reported having health insurance; however, only 40% of insured youth reported being able to independently use their insurance. Nearly two thirds (65%) reported being able to use their primary care source confidentially. Only 17% of adolescents had used a confidential care source other than their primary care provider. However, 32% were unable to identify any source of confidential care. Those with and without their own insurance cards were equally likely to identify an available source of confidential care. Females were much more likely than males to have used a confidential care source. More then half (56%) of all adolescents were sexually active; of these, 67% reported having ever discussed sexually transmitted diseases or their relationships with their provider(s). Many (41%) sexually active youth and only 6% of non-sexually active youth had used confidential care sources (p=0.02). CONCLUSIONS: Although half of all adolescents have their own insurance cards, many older adolescents remain unable to use their own insurance, obtain confidential primary care, or identify other available sources of confidential health care. Knowledge of available services and ability to use their health insurance remain substantial non-financial barriers to access for many adolescents.