In the broad context of the health care debate, one of the central issues remains: the uninsured. One-third of young adults are likely to be uninsured, and that number increases to almost 50 percent among black and Hispanic populations.

According to a study published recently in the Annals of Internal Medicine by UR Faculty member Robert Fortuna, young adults are the least likely to use ambulatory (outpatient) health care. Analyzing national statistics on outpatient care, Fortuna, a Doctor of Internal Medicine and Public Health Researcher, found mortality rates for young adults are more than double the rate for adolescents.

Fortuna’s study concluded that young adults receive less attention from researchers, advocates and policy makers than adolescents do, despite having higher risks for preventable diseases. It suggests that health-care providers and policy makers should pay closer attention to the access and preventative care needs of young adults.
While lack of health insurance is a major barrier, it is not the whole story.

‘Insurance status does not count for everything,” Fortuna said. ‘Even young adults with insurance need to navigate the system” Navigating the health care system involves more than calling a doctor when one is sick.

According to Fortuna, health literacy is a public health term that refers to the ability to read, understand and use health care information. This involves researching the best health-care plans, knowing when to call a doctor and understanding additional costs associated with health-care-like co-pays and deductibles.

Laura Shone, who has federal funding from the National Institutes of Health and is an Assistant Professor of Pediatrics and Clinical Nursing at Strong Memorial Hospital, agreed with the complexity of navigating the health care system.

‘It could be hard for young adults to understand why health insurance is important, to make sense of their choices for health insurance and choose a plan that matches their needs or to manage their health if they are uninsured and unable to get advice from a health care provider,” she said.

The study identifies many possible reasons for low usage statistics among young adults, including lack of health insurance, low perceived risk and lack of access to preventative care.

Young men are especially lacking in preventative care services. On average, insured young men are seen for preventative care services once every nine years; uninsured men are likely to be seen once every 25 years, with blacks and Hispanics using ambulatory services less.

According to Fortuna, young men do not have an established pathway to access primary care, while women tend to have access through gynecological care. For example, if a young woman goes in for her regular Pap smear, she may be more likely to talk to her doctor about other health issues. Young men do not have those access points and are more likely to ignore health issues until they need more serious attention.

Even though the study excluded college and school-based health services, Fortuna points out that college students represent a very small minority of people in the 20- to 29-year-old demographic. Also, many of high school and college students’ first jobs do not provide health benefits.

Graduating seniors may face the potentially confusing health care system. Individual, nonemployer-based programs are often prohibitively expensive.

As of July, New York State law allows unmarried, dependent young adults to stay on their parent’s employer-based insurance until age 29.

The legislation was passed to help reduce the 31 percent of uninsured young people currently living in New York State.

University Health Service Director Ralph Manchester agrees that the system is complex. UR mandates a health fee and insurance coverage for all full-time students. Students can buy University-sponsored insurance or buy their own coverage.

Thirty-five hundred graduate and undergraduate students choose the University-based option, which does not deny anyone coverage based on pre-existing conditions.

After graduation, UR students have the option of staying on the UR-based plan, but would have to pay significantly more for the same amount of coverage.

‘Students at the University of Rochester are in much better shape, but then there’s graduation,” Manchester said.

According to Manchester, many other colleges, especially public schools and community colleges, do not require that their students buy health insurance.

According to Associate Director of Health Promotion Linda Dudman, UHS sends out a short letter to graduating seniors in April about future steps. The paragraph on health insurance reads:

‘Now is the time to think about health insurance coverage after graduation.

‘Due to the high cost of health care, it is very risky to be without health insurance. We suggest you check your insurance plan and explore options for coverage after graduation.”

The paragraph provides no specifics about how to research plans, although there is limited information on the UHS Web Site.

Manchester argues that the system itself is flawed. He believes people should not have to think about insurance coverage every time they change jobs or employment status.

‘What we really need is a system that covers everyone regardless of whether they are a student, unemployed or anything else,” Manchester said. ‘Our system as a whole fails to cover 16 percent of the entire population, but that number is much higher among young adults.”

Sahay is a member of
the class of 2010.



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