Recent Trends in Insurance Status of Hospitalized Adolescents in New York State

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Recent Trends in Insurance Status of Hospitalized
Adolescents in New York State

• Niev J. Duffy, PhD
• Mount Sinai Adolescent Health Center
• The Mount Sinai Medical Center
• New York, New York

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Objective
To explore recent trends in the health insurance
status of adolescents hospitalized in New York
State and the extent to which they reflect
changes in the health insurance status of
adolescents in the broader population. To
evaluate the potential public health implications
of these trends.
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Methods
The author analyzed data from eleven years of the
New York State SPARCS hospital discharge data and
the March Supplement of the Current Population
Survey in order to identify trends in type of
insurance and rates of self-pay among the
adolescent patient population.
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RESULTS

• Trends in Hospital Discharges
• Decline in rates of adolescent hospital
  discharges since 1989.
• Decline in rates of Medicaid coverage among
  adolescent hospital discharges since 1994.
• Rising rates of self-pay hospital discharges
  since 1994.
• Far lower rates of private coverage for hospital
  discharges among older adolescents.
• Trends are more pronounced in New York City than
  in New York State.

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RESULTS

• Causes
• Declining adolescent access to private health
  insurance.
• Declining access to public health insurance among
  older adolescents.

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IMPLICATIONS FOR COMMUNITY HEALTH

• The rising share of uninsured among
  children/young adults imposes a strain on the
  resources of health care institutions providing
  services to this population, at a time when
  cost-shifting is increasingly difficult.
• Financial difficulties are worsened by cuts in
  health care subsidies and declining reimbursement
  rates, as well as declining funding for
  reproductive health care.

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IMPLICATIONS FOR COMMUNITY HEALTH

• The current economic downturn is likely to
  accelerate the decline in private health
  insurance leading to rising rates of
  uninsurance.
• The loss of Medicaid coverage may accelerate as
  recipients of public assistance reach the 5 year
  welfare reform limit.

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IMPLICATIONS FOR COMMUNITY HEALTH

• Ultimately, continued financial difficulties lead
  to declining quality of care or denial of
  services to the uninsured.
• Rising uninsurance leads to rising demands on the
  resources of Medicaid and CHIP.
• Financially troubled health care institutions cut
  community services.