The availability, nature, and content of health services for adolescents are profoundly affected by the ability to pay for those services through public and private health insurance. Fundamentally, money matters, and policies matter with respect to financing systems. This chapter focuses on these two contextual characteristics. It examines the extent to which adolescents have adequate insurance coverage for the health services they need; the emphasis is on financing issues and the public policies that relate to health insurance coverage. The discussion addresses limitations of the current financing system for adolescent health services with respect to both the lack of health insurance coverage and shortcomings of the coverage for adolescents who are insured.


As is true for all Americans, adolescents who are medically uninsured often receive care late in the development of a health problem or not at all. As a result, they are at higher risk for hospitalization for conditions amenable to timely outpatient care and for missed diagnoses of serious and even life-threatening conditions (Institute of Medicine, 2002a). As discussed in Chapter 2, some conditions (e.g., injuries, asthma) are particularly important in the adolescent population, and without timely care, frequently lead to unnecessary hospitalization. Additionally, dental care accounts for only 4.4 percent of total U.S. health expenditures for the general population, but accounts for 29.2 percent of health expenditures among those aged 6–17 compared with 37.3 percent for all other ambulatory health services (Cohen et al., 1996). This section examines how a lack of health insurance relates to limitations in adolescents’ access to needed health services, reviews disparities in insurance coverage and eligibility for adolescents, and describes some approaches that could be used to address these issues.


Those who lack health insurance are much more likely to go without health care than the insured (Institute of Medicine, 2001). The Institute of Medicine (IOM) has presented important evidence that being medically uninsured has a negative effect on health-related outcomes and chronic conditions among adults. The IOM study included a review of research investigating the health of working adults with and without health insurance (Institute of Medicine, 2002a). In a follow-up to that study, the IOM examined the impact of uninsurance on families, children, and adolescents. In this IOM study and other research, it was found that adolescents who lack health insurance coverage have worse access to needed health services than those who have coverage, although barriers remain for insured adoles-

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