Published online July 1, 2005
PEDIATRICS Vol. 116 No. 1 July 2005, pp. 88-95 (doi:10.1542/10.1542/peds.2004-1449)
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Uninsurance and Health Care Access Among Young Adults in the United States

S. Todd Callahan, MD, MPH* and William O. Cooper, MD, MPH{ddagger}

* Division of Adolescent Medicine and Behavioral Science
{ddagger} Division of General Pediatrics and the Center for Health Services Research, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee

Objective. Young adults who are 19 to 24 years of age are the most likely age group to be uninsured in the United States, yet little is known about how uninsurance might affect health care access among young adults. The objective of this study was to describe the association between health insurance status and health care access among young adults while controlling for other determinants of access to care.

Methods. We conducted a cross-sectional analysis of data from 11 866 19- to 24-year-old respondents who completed the National Health Interview Survey between 1998 and 2001. We present percentages and adjusted relative risk of young adults who in the previous year delayed or missed medical care because of cost, did not fill a prescription because of cost, had not spoken to a health professional, or identified no usual source of health care.

Results. Among the young adults studied, 27% of women and 33% of men were uninsured. After potential confounders were adjusted for, the uninsured remained at significantly higher risk for reporting delayed or missed medical care (women: adjusted relative risk [95% confidence interval]: 3.24 [2.72–3.82]; men: 4.31 [3.44–5.34]), not filling a prescription because of cost (women: 3.27 [2.55–4.16]; men: 4.05 [2.78–5.81]), having no contact with a health professional (women: 2.54 [2.01–3.09]; men: 1.60 [1.43–1.77]), and having no usual source of health care (women: 3.45 [3.05–3.90]; men: 2.27 [2.06–2.48]) relative to privately insured peers. Women with Medicaid did not differ significantly from privately insured women in these measures.

Conclusions. Uninsured young adults were significantly more likely than privately insured peers to report barriers to obtaining needed care, having no contact with a health professional, and identifying no usual source of health care. Given the high rates of uninsurance among young adults, additional study is needed to examine how these barriers affect the immediate and future health of the young adult.

Key Words: access to health care • adolescent medicine • uninsured • young adults

Abbreviations: NHIS, National Health Interview Survey • HMO, health maintenance organization • SCHIP, State Children’s Health Insurance Plan • AOR, adjusted odds ratio • CI, confidence interval

Accepted Oct 14, 2004.


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