THE IMPACT OF HEALTH-INSURANCE STATUS ON ADOLESCENTS UTILIZATION OF SCHOOL-BASED CLINIC SERVICES - IMPLICATIONS FOR HEALTH-CARE REFORM

Purpose: 1) To examine Variations among students with different health insurance coverage in their use of school-based clinics (SBCs), reaso ns for not receiving health care when needed, and reasons for using or not using SBCs, and 2) to determine if insurance status is a signific ant factor in predicting SEC use, after controlling for demographic va riables and health status. Methods: Confidential questionnaires were a dministered to 2,860 adolescents attending 3 urban high schools with o n-site SBCs. Chi-square and multiple logistic regression analyses were used to assess differences among insurance groups in patterns of SEC use and reasons for clinic use/nonuse. Results: Students with private insurance or HMO coverage had the highest rates of SEC utilization (67 % and 66%) and students without health insurance and with Medicaid had the lowest (57% and 59%) (p < 0.01). While there was no difference am ong adolescents according to insurance group membership in their use o f SEC medical services, a significantly higher proportion of students with Medicaid coverage used SEC mental health services. Students witho ut health insurance were less likely to receive health care from any s ource when it was needed. After controlling for demographic variables and health status, no insurance factors remained significant. Conclusi ons: SEC users represent a variety of insurance groups. Health care re form efforts need to take into account the special needs of adolescent s and the challenges they face in accessing care that go beyond financ ial barriers to care. SEC have been shown to provide a convenient and acceptable source of care, as well as offering the opportunity to prov ide preventive and primary care services to at-risk youth. As the coun try moves to a managed care environment potential partnerships with SB Cs represent a unique opportunity to improve the delivery of care to a dolescents, assuring increased access to a package of health services that they need.