ADOLESCENTS KNOWLEDGE OF THEIR HEALTH-INSURANCE COVERAGE

Purpose: To determine the accuracy of adolescents' self-report of heal th insurance coverage, using parents' report as a comparison standard. Methods: Two separate samples of urban, school-based adolescents and their parents completed self-administered questionnaires about type of health insurance coverage. Sample 1 included 123 and Sample 2 include d 93 adolescent-parent pairs. Percent agreement and the kappa statisti c were determined for each of the sample groups, and for males versus females and older (>14 years) versus younger (less than or equal to 14 years) adolescents. Results: In Sample 1, 33% of adolescent responden ts responded ''don't know'' to the question about type of insurance co verage, and 4% left the question blank; in Sample 2, 3% answered ''don 't know,'' with none leaving the question blank. For Sample 1, we foun d a 57% rate of agreement of adolescents with their parents, and a cor responding kappa of .21. Females and older subjects demonstrated great er accuracy, with kappa's all in the range .13-.29. In Sample 2, 73% o f subjects agreed with parents' report, with a kappa of .48. Females a nd older subjects also demonstrated greater accuracy with the highest kappa of .59 demonstrated by older females. Excluding those responding with ''don't know,'' we found overall percent agreement with parents of 87% in Sample 1 and 73% in Sample 2; the corresponding kappas were .47 and .51. Females demonstrated higher agreement with parents in bot h samples. The results stratifying by age were inconsistent. In Sample 1, privately insured subjects were more accurate reporters than those either on medical assistance or uninsured. In Sample 2 no differences were seen by type of insurance. Conclusions: Many adolescents do not know their health insurance coverage status. However, for those who di d claim to know, acceptable rates of accuracy using both percent agree ment and the kappa statistic were demonstrated. Further research is ne eded to determine how information about insurance is communicated to a dolescents and how this knowledge affects access to and use of health services. (C) Society for Adolescent Medicine, 1998.