cents as well, as discussed later in this chapter (Callahan and Cooper, 2005; Ford, Bearman, and Moody, 1999; Institute of Medicine, 2002b; Klein et al., 2006; Lieu, Newacheck, and McManus, 1993; National Adolescent Health Information Center, 2005; Newacheck et al., 1999; Shenkman, Youngblade, and Nackashi, 2003; Yu et al., 2001). Gaps in insurance coverage, particularly for mental health and dental services, also appear to cause access problems (Olson, Tang, and Newacheck, 2005).

Table 6-1 shows how access to care differs between adolescents who are medically insured and uninsured along a number of different dimensions: failure to get needed medical care because of cost, delays in getting needed care because of cost, failure to get needed prescription drugs because of cost, the absence of a usual source for health care, and failure to see a physician in the past year (tabulations based on data from the 2004–2005 National Health Interview Survey).1 For each measure, the medically uninsured are worse off than those with public or private coverage. For example, 13 percent of those aged 10–18 who were uninsured failed to get needed medical care and 11 percent to get needed prescription drugs because of cost, compared with 2.6 percent and 4.3 percent, respectively, for those with public coverage and 1.1 percent and 2.1 percent, respectively, for those with private coverage. Similarly, almost half of the medically uninsured in this age group lacked a usual source of care, and 41 percent had not seen a physician during the past year, compared with 6.6 and 14.4 percent, respectively, for those with public coverage and 3.6 and 11.8 percent, respectively, for those with private coverage. The discrepancy between levels of access to care enjoyed by the medically insured and uninsured is the greatest for those with poor health. Those with multiple risk factors can suffer quite severe limitations in access to care. Thus, 16.1 percent of uninsured adolescents aged 10–18 who reported fair or poor health status failed to get medical care because of cost in 2004–2005, compared with 5.3 percent of their counterparts covered by public insurance (tabulations based on data from the U.S. National Health Interview Survey, 2004–2005).

According to the 2004 Medical Expenditure Panel Survey, three-fourths (76.4 percent) of U.S. adolescents aged 13–20 had dental coverage from either private (55.7 percent) or public (23.6 percent) sources. This represents a significant increase in coverage subsequent to enactment of the State Children’s Health Insurance Program (SCHIP), with public dental coverage increasing for eligible children and adolescents by 73 percent between 1996 and 2004 (from 12.0 to 20.7 percent). However, the disparity between services provided to medically insured and uninsured adolescents is typi-

1

Insurance status is defined as of the time of the survey. Public coverage includes Medicaid, the State Children’s Health Insurance Program (SCHIP), and other state coverage, while private coverage includes employer-sponsored and nongroup coverage.



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