Recent Trends in Insurance Status of Hospitalized Adolescents in New York State Niev J. Duffy, PhD Mount Sinai Adolescent Health Center The Mount Sinai Medical Center New York, New York

Objective To explore recent trends in the health insurance status of adolescents hospitalized in New York State and the extent to which they reflect changes in the health insurance status of adolescents in the broader population. To evaluate the potential public health implications of these trends.

Methods The author analyzed data from eleven years of the New York State SPARCS hospital discharge data and the March Supplement of the Current Population Survey in order to identify trends in type of insurance and rates of self-pay among the adolescent patient population.

RESULTS Trends in Hospital Discharges  Decline in rates of adolescent hospital discharges since  Decline in rates of Medicaid coverage among adolescent hospital discharges since  Rising rates of self-pay hospital discharges since  Far lower rates of private coverage for hospital discharges among older adolescents.  Trends are more pronounced in New York City than in New York State.

RESULTS Causes  Declining adolescent access to private health insurance.  Declining access to public health insurance among older adolescents.

IMPLICATIONS FOR COMMUNITY HEALTH  The rising share of uninsured among children/young adults imposes a strain on the resources of health care institutions providing services to this population, at a time when cost-shifting is increasingly difficult.  Financial difficulties are worsened by cuts in health care subsidies and declining reimbursement rates, as well as declining funding for reproductive health care.

IMPLICATIONS FOR COMMUNITY HEALTH  The current economic downturn is likely to accelerate the decline in private health insurance leading to rising rates of uninsurance.  The loss of Medicaid coverage may accelerate as recipients of public assistance reach the 5 year welfare reform limit.

IMPLICATIONS FOR COMMUNITY HEALTH  Ultimately, continued financial difficulties lead to declining quality of care or denial of services to the uninsured.  Rising uninsurance leads to rising demands on the resources of Medicaid and CHIP.  Financially troubled health care institutions cut community services.