Underinsurance impacts teens' access to care
Are adolescents getting the care they need when it comes to reproductive health? According to a new policy statement issued by two committees of the American Academy of Pediatrics (AAP), underinsurance is an added barrier to teens' access to preventive, reproductive, and behavioral health care services.1
Adolescents need comprehensive reproductive health care. Preliminary data from 2007 indicate the birth rate among U.S. teens ages 15-19 increased to 42.5 per 1,000, up from 41.9 in 2006 and 40.5 in 2005.2
Teens also are at increased risk for sexually transmitted infections (STIs). The Centers for Disease Control and Prevention (CDC) estimates that about 19 million new STIs occur each year, with almost half among young people ages 15-24.3
The American College of Obstetricians and Gynecologists (ACOG) recommends that a teen first visit an obstetrician/gynecologist between ages 13 and 15.4 Getting acquainted with a provider in the early teens helps develop a trusting relationship, says Douglas Kirkpatrick, MD, ACOG president. This relationship allows the teen and provider to discuss pregnancy prevention and STIs, whether a teen has started having sex or not, he notes. "The goal is to boost a teen's comfort level; so, if she starts having sex, has questions about her reproductive health and development, needs advice on birth control, or has any other kind of problem, there is a reliable and knowledgeable source that she can consult," Kirkpatrick states.
Underinsurance, defined
How does underinsurance affect adolescent care? Margaret Blythe, MD, FAAP, FSAM, professor of pediatrics and adjunct professor of gynecology at the Indiana University School of Medicine in Indianapolis, says, "Underinsurance means the patient has copays and/or high deductibles that need to be paid out of pocket as part of their plan. With limited resources, these needs often go unmet, particularly if the teen needs to have confidential health care."
From the patient's perspective, underinsurance results in an inability to access appropriate reproductive health care, explains Blythe, chair of the AAP's Committee on Adolescence and co-author of the policy statement. From the provider's perspective, it translates into an inability to provide developmentally appropriate health care, including confidential screening and treatment for STIs, and provide prescriptions covered by insurance for contraception, she notes. "From a public health perspective, underinsurance of adolescents results in higher rates of undetected and untreated STIs, with increased rates of health consequences such as pelvic inflammatory disease, ectopic pregnancies, and abdominal pain, as well as increased rates of unplanned pregnancies," Blythe says.
Expect to see more youth with no private insurance, according to a new report by the Institute of Medicine.5 One in every 10 children in the United States had no health insurance in 2007, and the cost of insurance to families and employers is increasing, the report states.5 With health care costs rising and revenues declining, fewer employers are offering health insurance. From 2007 to 2009, the number of people covered by employer-sponsored insurance decreased by 8.9 million.6
State-sponsored public services are feeling the economic pinch as well. The number of children covered by Medicaid and the State Children's Health Insurance Program (SCHIP), the two major U.S. public health care systems, increased by 954,000 between 2006 and 2007.7 As of 2008, SCHIP alone provided coverage to 7 million children. Between 2007 and 2009, the number of people enrolled in Medicaid and SCHIP increased by 3.6 million.
On average, fee-for-service Medicaid rates are nationally about 80% of Medicare rates; reimbursement rates for caring for adolescent patients enrolled in Medicaid risk-based programs are lower.6 This difference in reimbursement can be problematic for providers who see large numbers of patients with Medicaid coverage.8
Publicly funded coverage such as Medicaid and the State Children's Health Insurance Program (SCHIP), and to a certain extent, some private policy coverage, fail to reimburse physicians properly for the time needed to care for adolescents, the AAP committee policy states.1 In addition, many private insurers do not recognize adolescent medicine specialists as both primary care providers and specialists, which can pose difficulties in reimbursement.
To make sure that adolescents receive the reproductive health care they need, the AAP committee statement calls for the following changes:
- Insurers should cover all contraceptives, including emergency contraception and treatment of STIs, just as they do other medications.
- Copayments, coinsurance, and deductibles for reproductive health care visits and contraceptives should be reduced or eliminated.
- Policies that recognize the rights of adolescents to obtain confidential reproductive health care should be developed by insurers, their governing organizations, and physician offices.
- A unique coding and billing strategy should be implemented by insurers to protect the rights of teenagers to access confidential reproductive health care services.
- Explanations of benefits and other receipts for reproductive care services used by adolescents ideally should not be sent to parents.
- Insurers should recognize that physicians trained in adolescent medicine may provide services as both primary care providers and specialists. Allowing adolescent medicine specialists to provide reproductive health care for teenagers within the context of primary care or consultative services would be a management strategy that serves the needs of the patients clinically and provides cost-effective treatment.
- Incentives should be offered for increased availability of after-hours care through higher payments for visits after 5 p.m. and on weekends.1
References
- American Academy of Pediatrics Committee on Adolescence; American Academy of Pediatrics Committee on Child Health Financing. Underinsurance of adolescents: Recommendations for improved coverage of preventive, reproductive, and behavioral health care services. Pediatrics 2009; 123:191-196.
- Hamilton BE, Martin JA, Ventura SJ. Births. Preliminary data for 2007. National vital statistics reports, web release; vol. 57, no. 12. Hyattsville, MD: National Center for Health Statistics; March 18, 2009.
- Weinstock H, Berman S, Cates Jr. W. Sexually transmitted diseases among American youth: Incidence and prevalence estimates, 2000. Perspect Sex Reprod Health 2004; 36:6-10.
- American College of Obstetricians and Gynecologists. Teens Need Comprehensive Reproductive Health Care, Sex Ed. Press release. May 4, 2009.
- Committee on Health Insurance Status and Its Consequences, Institute of Medicine. America's Uninsured Crisis: Consequences for Health and Health Care. Washington, DC; National Academies Press; 2009.
- Henry J. Kaiser Family Foundation. Impact of the Rise in Unemployment on Health Coverage, 2007 to 2009. Accessed at slides.kff.org/chart.aspx?ch=878.
- Zuehlke E. Economic recession presents further challenges to uninsured children in the United States. Accessed at www.prb.org/Articles/2009/usuninsuredchildren.aspx.
- Pupillo J. What's wrong with the health care system for insured adolescents? AAP News2009; 30:7.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content