Overall Conclusion 5: Large numbers of adolescents are uninsured or have inadequate health insurance, which can lead to a lack of access to regular primary care, as well as limited behavioral, medical, and dental care. One result of such barriers and deficits is poorer health.

More than 5 million adolescents aged 10–18 are uninsured. Uninsured rates are higher among the poor and near poor, racial and ethnic minorities, and noncitizens. As is true for all Americans, uninsured adolescents are less likely to have a regular source of primary care and use medical and dental care less often than those who have insurance. Having health insurance, however, does not ensure adolescents’ access to affordable, high-quality services given current shortages of health care providers and problems associated with high out-of-pocket cost-sharing requirements, limitations in benefit packages, and low provider reimbursement levels. This is especially true in areas that involve counseling or case management of multiple health conditions, and in areas that are particularly problematic for adolescents, such as obesity, intentional and unintentional injury, mental health, dental care, and substance abuse. Furthermore, uninsured adolescents aged 10–18 who are eligible for public coverage often are not enrolled either because their parents do not know they are eligible or because complexities of the enrollment processes deter participation.

Overall Conclusion 6: Health care providers working with adolescents frequently lack the necessary skills to interact appropriately and effectively with this age group.

Whether providers report on their own perceptions of their competencies or adolescents describe the care they have received, data reveal significant gaps in the achievement of a well-equipped and appropriately trained workforce ready to meet the health needs of adolescents. At all levels of professional education, health care providers in every discipline serving adolescents should receive specific and detailed education in the nature of adolescents’ health problems and have in their clinical repertoire a range of effective ways to treat and prevent disease in this age group, as well as to promote healthy behavior and lifestyles within a developmental framework. Evidence suggests this currently is not the case.

Overall Conclusion 7: The characterization of adolescents and their health status by such traditional measures as injury and illness does not adequately capture the developmental and behavioral health of adolescents of different ages and in diverse circumstances.

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