March 10, 2006

Bumps in road from child to adult care studied

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Todd Callahan, M.D., M.P.H.

Bumps in road from child to adult care studied

Todd Callahan, M.D., M.P.H., had seen it a number times — an adolescent with chronic health problems he had been treating for years would quietly disappear at age 18.

Later he would get a call to consult on that same patient in the Emergency Department. When asked what had been happening with their health care after age 18, Callahan says the young patients would tell him they had lost their insurance coverage, and many had not been getting regular care since.

To quantify this problem, Callahan got together with Bill Cooper, M.D., M.P.H. The pair work in the Child and Adolescent Health Research Unit at the Monroe Carell Jr. Children's Hospital at Vanderbilt, and together they searched through surveys provided by one of the largest health survey databases in the country, the National Health Interview Survey (NHIS).

Callahan and Cooper reviewed the status of young adults age 19 to 29, who by NHIS's definition (shared by the World Health Organization) were disabled because of a chronic health problem. They found that young disabled adults are prone to losing the health care insurance that had helped keep their chronic illness in check for years.

“Even though this is a group of young adults that is highly motivated to seek insurance coverage, they were just as likely as healthy young adults to be completely uninsured,” Callahan said. “And it appears to have a serious impact on their health care.”

The results of this survey are in February's Archives of Pediatric and Adolescent Medicine.

In the article, entitled “Access to Health Care for Young Adults With Disabling Chronic Conditions,” Callahan and Cooper found 26 percent of young adults who are disabled reported having no insurance, close to the number of healthy young adults who also reported no insurance (28 percent).

“What's more important is that more than two-thirds of uninsured respondents with a disabling chronic condition reported an unmet health need and 45 percent reported no usual source of care,” said Callahan.

That means that young adults with a chronic illness that has led to disability are eight times more likely to have unmet health needs than their healthy, and similarly uninsured, counterparts of the same age.

Callahan and Cooper say this is strong evidence that programs are needed to help transition children with chronic health needs into the world of adult medicine. Since many children enjoy insurance under their parents' health care plans, they begin young adulthood in a place where preventive measures might help keep them from becoming further disabled. However, once these children leave their parents' insurance plans, usually at age 18 or at the end of college, it may be difficult for them to find a good health care plan in adulthood.

Callahan says he believes these young people should have guidance from the medical community to get the minimum of preventive care that might keep them out of emergency rooms.

“A full one-third of children who are eligible for disability as a child will no longer be eligible for the more stringent definitions of disability in adulthood,” Callahan said. “This group should be a higher priority for us. These children might face greater disability later on if they receive less help in adulthood.”