Adolescents' knowledge of their health insurance coverage.
OBJECTIVE
To determine the accuracy of adolescents' self-report of health insurance coverage, using parents' report as a comparison standard.


METHODS
Two separate samples of urban, school-based adolescents and their parents completed self-administered questionnaires about type of health insurance coverage. Sample 1 included 123 and Sample 2 included 93 adolescent-parent pairs. Percent agreement and the kappa statistic were determined for each of the sample groups, and for males versus females and older (> 14 years) versus younger (< or = 14 years) adolescents.


RESULTS
In Sample 1, 33% of adolescent respondents responded "don't know" to the question about type of insurance coverage, and 4% left the question blank; in Sample 2, 3% answered "don't know," with none leaving the question blank. For Sample 1, we found a 57% rate of agreement of adolescents with their parents, and a corresponding kappa of .21. Females and older subjects demonstrated greater accuracy, with kappa's all in the range .13-.29. In Sample 2, 73% of subjects agreed with parents' report, with a kappa of .48. Females and older subjects also demonstrated greater accuracy, with the highest kappa of .59 demonstrated by older females. Excluding those responding with "don't know," we found overall percent agreement with parents of 87% in Sample 1 and 73% in Sample 2; the corresponding kappas were .47 and .51. Females demonstrated higher agreement with parents in both samples. The results stratifying by age were inconsistent. In Sample 1, privately insured subjects were more accurate reporters than those either on medical assistance or uninsured. In Sample 2, no differences were seen by type of insurance.


CONCLUSIONS
Many adolescents do not know their health insurance coverage status. However, for those who did claim to know, acceptable rates of accuracy using both percent agreement and the kappa statistic were demonstrated. Further research is needed to determine how information about insurance is communicated to adolescents and how this knowledge affects access to and use of health services.
Ryan
S A
SA
Division of Adolescent Medicine, University of Rochester School of Medicine and Dentistry, New York, USA.
Millstein
S G
SG
Kang
M
M
Ensminger
M E
ME
Starfield
B
B
Irwin
C E
CE
D000293:Adolescent; D000328:Adult; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006302:Health Services Research; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D011795:Surveys and Questionnaires; D014505:Urban Population