Improving access to health services for adolescents from economically disadvantaged families.

An analysis of the health status and health care utilization patterns of poor and nonpoor adolescents was conducted using a sample of 22,792 adolescents 10 to 18 years of age from the 1983 and 1984 National Health Interview Surveys. The results indicate that adolescents from families with incomes below the poverty level were three times as likely to be reported in only fair or poor health status and were 47% more likely to suffer from disabling chronic illnesses than adolescents from families with incomes above the poverty level. Use of inpatient hospital services was similar for adolescents from poor and nonpoor families when health status was controlled. However, adolescents from poor families were 35% more likely than those from nonpoor families to have waited 2 or more years between physician contacts. In addition, poor adolescents made 13% fewer physician contacts on an annual basis when compared with nonpoor adolescents. Substantial differences in utilization rates were found when poor adolescents were disaggregated according to whether they were covered by Medicaid. Those with Medicaid coverage used physician services at rates similar to nonpoor adolescents, whereas those without Medicaid coverage lagged substantially behind. Based on the conclusion that Medicaid is effective in reducing barriers to needed services, strategies for expanding Medicaid eligibility to additional low-income adolescents are discussed.