Recent Trends in Insurance Status of Recent Trends in Insurance Status of Hospitalized Adolescents in Hospitalized Adolescents in

New York StateNew York State

Niev J. Duffy, PhDNiev J. Duffy, PhD

Mount Sinai Adolescent Health CenterMount Sinai Adolescent Health Center

The Mount Sinai Medical CenterThe Mount Sinai Medical Center

New York, New YorkNew York, New York

ObjectiveObjective

To explore recent trends in the health To explore recent trends in the health insurance status of adolescents hospitalized insurance status of adolescents hospitalized in New York State and the extent to which in New York State and the extent to which they reflect changes in the health insurance they reflect changes in the health insurance status of adolescents in the broader status of adolescents in the broader population. To evaluate the potential public population. To evaluate the potential public health implications of these trends.health implications of these trends.

MethodsMethods

The author analyzed data from eleven years of The author analyzed data from eleven years of the New York State SPARCS hospital the New York State SPARCS hospital discharge data and the March Supplement of discharge data and the March Supplement of the Current Population Survey in order to the Current Population Survey in order to identify trends in type of insurance and rates identify trends in type of insurance and rates of self-pay among the adolescent patient of self-pay among the adolescent patient population. population.

RESULTSRESULTS

Trends in Hospital DischargesTrends in Hospital Discharges Decline in rates of adolescent hospital discharges since 1989.Decline in rates of adolescent hospital discharges since 1989. Decline in rates of Medicaid coverage among adolescent Decline in rates of Medicaid coverage among adolescent

hospital discharges since 1994.hospital discharges since 1994. Rising rates of self-pay hospital discharges since 1994.Rising rates of self-pay hospital discharges since 1994. Far lower rates of private coverage for hospital discharges Far lower rates of private coverage for hospital discharges

among older adolescents.among older adolescents. Trends are more pronounced in New York City than in New Trends are more pronounced in New York City than in New

York State.York State.

RESULTSRESULTS

CausesCauses Declining adolescent access to private health Declining adolescent access to private health

insurance.insurance. Declining access to public health insurance Declining access to public health insurance

among older adolescents.among older adolescents.

IMPLICATIONS FOR COMMUNITY IMPLICATIONS FOR COMMUNITY HEALTHHEALTH

The rising share of uninsured among children/young The rising share of uninsured among children/young adults imposes a strain on the resources of health care adults imposes a strain on the resources of health care institutions providing services to this population, at a institutions providing services to this population, at a time when cost-shifting is increasingly difficult.time when cost-shifting is increasingly difficult.

Financial difficulties are worsened by cuts in health Financial difficulties are worsened by cuts in health care subsidies and declining reimbursement rates, as care subsidies and declining reimbursement rates, as well as declining funding for reproductive health care. well as declining funding for reproductive health care.

IMPLICATIONS FOR COMMUNITY IMPLICATIONS FOR COMMUNITY HEALTHHEALTH

The current economic downturn is likely to accelerate The current economic downturn is likely to accelerate the decline in private health insurance leading to rising the decline in private health insurance leading to rising rates of uninsurance. rates of uninsurance.

The loss of Medicaid coverage may accelerate as The loss of Medicaid coverage may accelerate as recipients of public assistance reach the 5 year welfare recipients of public assistance reach the 5 year welfare reform limit.reform limit.

IMPLICATIONS FOR COMMUNITY IMPLICATIONS FOR COMMUNITY HEALTHHEALTH

Ultimately, continued financial difficulties lead to Ultimately, continued financial difficulties lead to declining quality of care or denial of services to the declining quality of care or denial of services to the uninsured.uninsured.

Rising uninsurance leads to rising demands on the Rising uninsurance leads to rising demands on the resources of Medicaid and CHIP.resources of Medicaid and CHIP.

Financially troubled health care institutions cut Financially troubled health care institutions cut community services.community services.