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Teen well visits rise under ACA, but rates still low
Although well-visit rates improved modestly among adolescents after the ACA was implemented, less than 50% of adolescents received this preventive care measure, according to a study published in JAMA Pediatrics.
“In the context of a strong evidence base and professional consensus, the Patient Protection and ACA require that most private insurers cover many preventive services with no copay, including the services recommended by the AAP and the U.S. Preventive Services Task Force, grades A and B, as part of a larger focus on prevention throughout the ACA,” Sally H. Adams, PhD, from the division of adolescent and young adult medicine in the department of pediatrics at UCSF Benioff Children’s Hospital, and colleagues wrote.
“Since the ACA’s enactment, to our knowledge, few studies have examined the provision of preventive services among adolescents and we are unaware of any studies examining the provision of confidential care,” the researchers continued.
To assess whether adolescent well-visit rates increased from rates before the implementation of the ACA and to determine whether any past-year health care visits increased as reported by caregivers, the researchers conducted a secondary data analysis of Medical Expenditure Survey Data from 2007-2009 (pre-ACA implementation) and 2012-2014 (post-ACA implementation). Computer-assisted personal interviews were used to gather data from caregivers of 25,695 10- to 17-year-old adolescents.
Of the adolescents included in the study, 50.9% were male in the pre-ACA group, and 50.8% were male in the post-ACA group. Well visits were used more often by adolescents after ACA implementation, with the rates rising from 41% to 48% (OR = 1.3; 95% CI, 1.2-1.5). The greatest increases in well visits were observed in minority groups and those from low-income families.
For adolescents with any health care visit in the past year, eight of nine preventive service rates improved after the ACA was implemented (range = 2%-9%, absolute). When demographic variables were considered, little or no change was observed. Additionally, after implementation, adolescent time spent alone with providers increased by 1% (adjusted OR = 1.2; 95% CI, 1.0-1.3).
“The higher well-visit rate among full -year insured adolescents compared with uninsured adolescents indicates that insurance matters,” Adams and colleagues wrote. “However, it is not sufficient to ensure the provision of care: Less than half of full-year insured adolescents received a well visit. Efforts are needed to encourage greater use of the well visit.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.
