Promising approaches for adolescent reproductive health service delivery. The role of school-based health centers in a managed care environment.
Within the arena of adolescent health care, the most critical service delivery issue is access to care. Efforts to contain health care expenditures through managed care plans inevitably conflict with efforts to deliver truly comprehensive preventive services to all adolescents. Because of the substantial increase in risk behaviors, prevention efforts require frequent contacts if interventions are to be made before risk behaviors occur or soon after their onset. In addition, yearly screening for all adolescents is likely to identify many teens who could benefit from early interventions. Enabling school-based health centers to provide services in coordination with managed care systems would go far to ensure access to care, as well as appropriate attention to the special needs of adolescents, in a timely and cost-effective way. Furthermore, that access would not be tied solely to the family's choice of provider or to the provider mandated by the adolescent's insurance plan. Underlying any approach to coordination of services, however, is the need for managed care providers to understand and affirm a preventive care investment in young people as a means of reducing health care expenditures, an investment that would pay dividends not only during the adolescent years but into adulthood as well. Whether the willingness exists to make this investment, when the cost savings may not directly accrue to the adolescent's current HMO, presents a conflict between the present interests of the HMO and the future interests of whatever provider the adolescent sees as an adult. As managed care systems are more widely adopted, it will be important to ensure that they adequately incorporate the service delivery components that have been found to be efficacious in serving adolescents. Given the leading role school-based health centers can play in providing preventive health care and health promotion, managed care providers should be encouraged to develop strong partnerships with such centers, so that the dual goals of high-quality care and cost containment can be achieved.
Brindis
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National Adolescent Health Information Center, Institute for Health Policy Studies, San Francisco, CA 94109, USA.
D000293:Adolescent; D016497:Adolescent Health Services; D003695:Delivery of Health Care; D006801:Humans; D008329:Managed Care Programs; D012309:Risk-Taking; D012572:School Health Services; D014481:United States