Adolescent HMO enrollees' utilization of out-of-plan services

Purpose: To examine use of reproductive health services, correlates of out- of-plan care, and reasons for seeking out-of-plan care among adolescent hea lth maintenance organization (HMO) enrollees. Methods: We mailed a self-administered questionnaire to a population-based random sample of 18-year-old members of Group Health Cooperative of Puget S ound (GHC) who had been enrolled for at least 12 months. The sample was sel ected from GHC's computerized enrollment database. Questionnaire topics inc luded reproductive history, sexual behavior, and use of health services. An alysis included Chi-square tests to examine differences by gender and out-o f-plan status and multivariate analysis using logistic regression. Results: About one-half of the 997 respondents (69% response rate) reported using out-of-plan care. In multivariate analysis, the strongest correlate of out-of-plan care was having had sexual intercourse [odds ratio (OR) = 1. 84; 95% confidence interval (CI) = 1.35-2.52]. Other correlates were using alcohol (OR = 1.79; 95% CI := 1.29-2.48), living with parents (OR = 0.65; 9 5% CI = .46-.92), and being female (OR = 1.60; 95% CI = 1.21-2.11). During the prior year, over 80% of sexually active respondents had obtained contra ceptives out-of-plan and 45% of those tested for sexually transmitted disea ses (STDs) reported out-of-plan testing. The primary reasons reported for u sing any out-of-plan care were lack of convenience (28%), being out of town (26%), and confidentiality (23%; only reported by sexually active responde nts). Conclusions: A substantial proportion of GHC-enrolled adolescents used out- of-plan care. Those who did were more likely to have had STDs and other hea lth problems than those who used only in-plan services. Without continuity of can?, these at-risk adolescents may not be receiving optimal services. ( C) Society for Adolescent Medicine, 2001.