The Unique Health Care Needs of Adolescents

Article excerpt

Health insurance coverage plays a key role in meeting adolescents' needs by increasing their access to health care, yet adolescents are more likely to lack coverage than younger children. (1) One in seven adolescents ages 10 to 18 has no form of public or private insurance. (2) Even higher rates of uninsurance are found among low-income, black, and Hispanic adolescents. For low-income adolescents, insurance through public programs such as Medicaid and the State Children's Health Insurance Program (SCHIP) is particularly important. Like younger children without coverage, adolescents without insurance use fewer health services, receive care less frequently, return for fewer follow-up appointments, and are more likely to seek care in an emergency room. (3,4)

While most adolescents are healthy by traditional medical standards, a significant number of young people experience some serious physical or mental health problems or concerns. For example, approximately one in five adolescents suffers from at least one serious health problem, such as chronic conditions, asthma, or depression; and about one in four is believed to be at risk for early unprotected sexual intercourse or substance abuse. (5) Moreover, many health problems occur disproportionately among adolescents who are Medicaid and SCHIP eligible. Low-income adolescents, especially those of color, have higher rates of death, illness, and health risk behaviors in almost every category studied. (6) In addition, other subgroups of adolescents face special, heightened health risks and are more likely to have acute and complex health care needs. These groups include youth who have chronic physical or mental health conditions; live in foster or group homes; are homeless or have run away from home; are undocumented, migrant, or new immigrants; have limited English language skills; are incarcerated or involved in the juvenile justice system; or are pregnant or parenting. (7)

Making adolescent health a priority is especially timely because significant demographic changes are occurring in the United States. While adolescents will represent a smaller proportion of the overall population, the number of adolescents ages 10 through 19 is expected to grow from 39.8 million in 2000 to 42.3 million in 2020, a 6.4% increase. (8) Moreover, adolescent population projections anticipate far greater numbers of young people of color, who are more likely to live in poverty, be uninsured, and underutilize primary and preventive health care services. (9)

This article describes the particular health care needs of adolescents and explores the extent to which public health insurance programs are meeting those needs. It includes an overview of the coverage available to adolescents through Medicaid and SCHIP, how that coverage has evolved, the importance of providing comprehensive benefits to adolescents, and the need to adopt age-appropriate quality and performance measures to track progress over time. Throughout the article, recommendations are provided to strengthen health care services for adolescents, informed by the work of several national health care and policy organizations. (10)

Special Health Care Needs of Adolescents

Adolescence is a unique developmental stage of accelerated growth, when a number of physiological, cognitive, social, mad emotional changes occur simultaneously. Despite the lack of a formally established age range to define this developmental period, health professionals generally consider adolescence to include young people ages 10 through 19, or those ages 10 through 24. (11) During the transition from childhood into adolescence and again from adolescence into adulthood, youth have complex and important health care needs. Also, adolescence is a critical time to avoid the onset of health-damaging, risky, behaviors such as smoking and unsafe sexual activity that can lead to lifelong health problems. Thus, health care services for adolescents need to emphasize prevention, early intervention, mad education. …