State and national estimates of insurance coverage and health care utilization for adolescents with chronic conditions from the National Survey of Children's Health, 2003.
OBJECTIVE
To examine health and insurance characteristics of adolescents with special health care needs (ASHCN), at state and federal levels.


METHODS
We used the National Survey of Children's Health 2003, a nationally representative sample of children in the United States, to study adolescents 14-17 years of age. We present descriptive statistics and regression analyses of adolescents with and without special health care needs, regarding measures of health care use and insurance coverage.


RESULTS
Approximately 22% of adolescents 14-17 years old have a special health care need. On average, ASHCN have one more annual office visit per year than their non-SHCN peers (p < .001). ASHCN report three times the rate of unmet medical needs compared to their non-SHCN peers (p < .001), despite higher rates of insurance coverage (94% vs. 88%, p < .001). Overall, 26.9% of ASHCN have public coverage. Nationally, more than half of those ASHCN with public coverage report incomes above 100% of the federal poverty level (FPL), which puts them at risk for losing coverage when they age into adulthood. Across states, proportions of ASHCN on public coverage and with incomes > 100% FPL range from 3.2% to 37.5%.


CONCLUSIONS
One in six ASHCN currently has public coverage with household income that would make them ineligible by income criteria for continuing public coverage as adults. It is imperative to examine insurance continuity and corresponding health outcomes for ASHCN as they transition from child to adult health care settings, and to evaluate options for policy interventions that can sustain health care coverage for this vulnerable population.
Okumura
Megumi J
MJ
Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan, USA. okumuram@peds.ucsf.edu
McPheeters
Melissa L
ML
Davis
Matthew M
MM
D000293:Adolescent; D016497:Adolescent Health Services / Q000706:statistics & numerical data*; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D019988:Children with Disabilities; D005260:Female; D006301:Health Services Needs and Demand; D006305:Health Status Indicators; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D007407:Interviews as Topic; D008297:Male; D017057:Medically Uninsured; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012959:Socioeconomic Factors; D013221:State Health Plans / Q000706:statistics & numerical data*; D014481:United States