Theresa Andrasfay1. 1. Office of Population Research, Princeton University, Princeton, New Jersey. Electronic address: theresaa@princeton.edu.
Abstract
PURPOSE: The common practice of sending an explanation of benefits to policyholders may inadvertently disclose sensitive services to the parents of dependents, making confidentiality a potential barrier to reproductive health care. This study compares the reproductive health-care utilization of young adult dependents and young adult policyholders using nationally representative data collected after full implementation of the Affordable Care Act. METHODS: Data from 2,108 young adults aged 18-25 years in the 2015 National Health Interview Survey were analyzed. Logistic regressions predicted utilization of two preventive services (general doctor visit and flu vaccination) and four reproductive health services (HIV testing, obstetrician/gynecologist visit, hormonal contraceptive use, and Pap testing) from the insurance type of the young adult (dependent, privately insured policyholder, or Medicaid). RESULTS: In unadjusted analyses, young adult dependents had lower utilization of HIV tests than their peers who were privately insured or Medicaid policyholders. Young women dependents had lower utilization of Pap tests than young women on Medicaid. Once controls were included, young adult dependents did not have significantly lower odds of obtaining reproductive health care than privately insured policyholders. Dependent young men still had marginally lower odds of ever having an HIV test (adjusted odds ratio = .65, p = .08) and dependent young women still had marginally lower odds of ever having a Pap test (adjusted odds ratio = .58, p = .06) than comparable Medicaid policyholders. CONCLUSIONS: Despite confidentiality concerns, young adults insured as dependents have utilization of several reproductive health services similar to that of comparable young adult policyholders.
PURPOSE: The common practice of sending an explanation of benefits to policyholders may inadvertently disclose sensitive services to the parents of dependents, making confidentiality a potential barrier to reproductive health care. This study compares the reproductive health-care utilization of young adult dependents and young adult policyholders using nationally representative data collected after full implementation of the Affordable Care Act. METHODS: Data from 2,108 young adults aged 18-25 years in the 2015 National Health Interview Survey were analyzed. Logistic regressions predicted utilization of two preventive services (general doctor visit and flu vaccination) and four reproductive health services (HIV testing, obstetrician/gynecologist visit, hormonal contraceptive use, and Pap testing) from the insurance type of the young adult (dependent, privately insured policyholder, or Medicaid). RESULTS: In unadjusted analyses, young adult dependents had lower utilization of HIV tests than their peers who were privately insured or Medicaid policyholders. Young women dependents had lower utilization of Pap tests than young women on Medicaid. Once controls were included, young adult dependents did not have significantly lower odds of obtaining reproductive health care than privately insured policyholders. Dependent young men still had marginally lower odds of ever having an HIV test (adjusted odds ratio = .65, p = .08) and dependent young women still had marginally lower odds of ever having a Pap test (adjusted odds ratio = .58, p = .06) than comparable Medicaid policyholders. CONCLUSIONS: Despite confidentiality concerns, young adults insured as dependents have utilization of several reproductive health services similar to that of comparable young adult policyholders.