Young adults' health care utilization and expenditures prior to the Affordable Care Act.
OBJECTIVE
To examine young adults' health care utilization and expenditures prior to the Affordable Care Act.


METHODS
We used 2009 Medical Expenditure Panel Survey to (1) compare young adults' health care utilization and expenditures of a full-spectrum of health services to children and adolescents and (2) identify disparities in young adults' utilization and expenditures, based on access (insurance and usual source of care) and other sociodemographic factors, including race/ethnicity and income.


RESULTS
Young adults had (1) significantly lower rates of overall utilization (72%) than other age groups (83%-88%, p < .001), (2) the lowest rate of office-based utilization (55% vs. 67%-77%, p < .001) and (3) higher rate of emergency room visits compared with adolescents (15% vs. 12%, p < .01). Uninsured young adults had high out-of-pocket expenses. Compared with the young adults with private insurance, the uninsured spent less than half on health care ($1,040 vs. $2,150/person, p < .001) but essentially the same out-of-pocket expenses ($403 vs. $380/person, p = .57). Among young adults, we identified significant disparities in utilization and expenditures based on the presence/absence of a usual source of care, race/ethnicity, home language, and sex.


CONCLUSIONS
Young adults may not be utilizing the health care system optimally by having low rates of office-based visits and high rates of emergency room visits. The Affordable Care Act provision of insurance for those previously uninsured or under-insured will likely increase their utilization and expenditures and lower their out-of-pocket expenses. Further effort is needed to address noninsurance barriers and ensure equal access to health services.
Division of Adolescent and Young Adult Medicine, University of California, San Francisco, California. Electronic address: laujs@peds.ucsf.edu.
Josephine S
JS
Lau
Division of Adolescent and Young Adult Medicine, University of California, San Francisco, California.
Sally H
SH
Adams
Department of Epidemiology and Biostatistics, University of California, San Francisco, California.
W John
WJ
Boscardin
Division of Adolescent and Young Adult Medicine, University of California, San Francisco, California.
Charles E
CE
Irwin
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D019538:Health Care Surveys / Q000379:methods* / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019458:Insurance Coverage / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D058991:Patient Protection and Affordable Care Act / Q000191:economics* / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult
Affordable Care Act; Health care expenditures; Health care utilization; Young adults