National attention is currently focused on improving health services that are delivered to vulnerable, adolescent populations. An important first step in developing a new, high-quality health care model that addresses the needs of adolescents is to understand their current health services use. Medicaid and the State Children's Health Insurance Plan (SCHIP) provide critical, financial access to health care for adolescents in low-income families; yet, health services use by this population is not understood. The first two of three dissertation papers focus on how Medicaid insurance coverage definitions impact reported estimates of health services utilization. The first paper is a systematic review that describes Medicaid insurance definitions reported by researchers and explores the extent to which reported estimates of adolescent health services utilization differ by these definitions. The results from this review indicate that there is substantial variation in the estimates of adolescent health care utilization as a function of variation in Medicaid definitions. The second paper uses Rhode Island, Medicaid managed care data to empirically examine how estimates of adolescents' health care use vary as a function of three different, commonly used definitions of Medicaid coverage. Applying Medicaid definitions with more restrictive continuous enrollment requirements can result in the systematic selection of adolescents who use health services more frequently than the overall adolescent Medicaid population. When choosing a Medicaid definition, researchers should carefully consider the insurance instability of their target population.The third and final paper examines health services utilization by low-income adolescents in the United States. In this paper, the association between three broad measures of health care access and emergency department (ED) utilization by low-income adolescents is quantified. This study demonstrates that ED utilization by low-income adolescents differs substantially by gender. Of the three health care access measures studied, none were associated with ED utilization by males and only insurance coverage was associated with ED utilization for females. Our research suggests that improving the current model of adolescent health care will require addressing gender-specific health care needs and care seeking behaviors.
OHaire, Christen,
"Medicaid Enrolled Adolescents: Defining Populations and Evaluating Health Services Utilization"
(2010).
Epidemiology Theses and Dissertations.
Brown Digital Repository. Brown University Library.
https://doi.org/10.7301/Z06T0JWG
