KNOWLEDGE OF HEALTH-INSURANCE COVERAGE BY ADOLESCENTS AND YOUNG-ADULTS ATTENDING A HOSPITAL-BASED CLINIC

Purpose: To describe adolescents' and young adults' knowledge about th eir health insurance, and to identify factors associated with correct knowledge of health insurance in this population. Methods: Data were a nalyzed from a confidential questionnaire administered to 830 patients at a hospital-based adolescent medicine clinic. The questionnaire con tained items pertaining to insurance type, demographics, health status , and health-risk behaviors. Actual health insurance data and informat ion regarding utilization of health services were obtained from the ho spital billing database. Predictors of health insurance knowledge were determined through bivariate analyses followed by stepwise logistic r egression. Results: A total of 50.7% of respondents correctly identifi ed their type of health insurance. Those who correctly identified thei r insurance had a higher mean age. Only 48.5% of participants who were 11-18 years old could identify their insurance type, versus 53.1% of 19-21-year-olds and 64.7% of 22-24-year-olds (p = 0.02). Sixty-five pe rcent of Medicaid patients and 76.3% of hospital free care patients kn ew how their medical bills were paid, versus 17.9% of self-pay patient s and 47.3% of patients with private insurance (p < 0.01). Greater uti lization of health services was associated with increased rates of ins urance knowledge among 19-24-year-olds on bivariate analysis; however, this factor was not significant when controlling for other factors. R egression analysis revealed that older age and insurance type other th an self-payment were independent predictors of health insurance knowle dge in adolescents (11-18 years old), while female gender and insuranc e type other than self-payment were independent predictors of insuranc e knowledge in young adults (19-24 years old). Conclusions: Approximat ely half of adolescents and young adults do not know how their medical bills are paid. Validation of self-reported insurance data is, theref ore, critical both in clinical practice and health services research. (C) Society for Adolescent Medicine, 1998.