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Adolescent Health Services: Missing Opportunities
cally greater for dental care than for medical care because of the structure of dental coverage. Based on the National Survey of America’s Families, it is estimated that 42 percent of uninsured adolescents aged 11–17 failed to make recommended dental visits in a year, a rate three times higher than that for their privately insured counterparts. These uninsured adolescents were also 2.4 times more likely to miss recommended dental visits than medical health maintenance visits (Yu et al., 2002).
At all ages, those with private health insurance coverage access more dental care than those who are uninsured, even in the absence of a dental benefit plan. The federal Medical Expenditure Panel Survey found that among those aged 13–20, those with no health insurance were half as likely to make a dental visit in a year as those with private coverage (27.5 percent compared with 57.5 percent) (Manski and Brown, 2007). In contrast, having publicly financed coverage is far less predictive of making a dental visit, as children and adolescents with public coverage were only modestly more likely to do so than those who were uninsured (34.1 percent compared with 27.5 percent). Having dental coverage further increases the likelihood of receiving dental care. Among children and adolescents under age 18, more than half (55.6 percent) of those with no insurance did not make a preventive dental visit in a year, while only half as many who had medical coverage (27.7 percent) and a third as many with both medical and dental coverage (19.9 percent) went without preventive dental care (Kenney, McFeeters, and Yee, 2005).
Many adolescents fall through the cracks in the insurance system because of gaps in both public and private coverage (Collins et al., 2006, 2007). More than 4 million individuals aged 10–18 have no health insurance coverage whatsoever, according to recent census data (tabulations based on data from the 2005 Current Population Survey).2 It is striking to note that if those aged 19–24 are included, this figure rises to more than 12 million.
Disparities in Coverage by Selected Population Characteristics
For adolescents, medically uninsured rates are higher for those with lower income, for Hispanics (and to a lesser extent for African Americans) compared with whites, and for noncitizens compared with citizens (see Figure 6-1) (tabulations in this section are based on data from the 2005 Current Population Survey). Uninsured rates are also higher for those in
These estimates have been adjusted for the underreporting of public coverage on the Current Population Survey.