TY - JOUR
T1 - Adolescents' knowledge of their health insurance coverage
AU - Ryan, Sheryl A.
AU - Millstein, Susan G.
AU - Kang, Myungsa
AU - Ensminger, Margaret E.
AU - Starfield, Barbara
AU - Irwin, Charles E.
N1 - Funding Information:
The authors thank all members of the Bay Area Teen Health Project at USCF and the members of the CHIP team at Johns Hopkins University for their assistance with data collection and preparation; Rebecca Lee for assistance with preparation of the manuscript; and Peggy Auinger with statistical assistance. (This research was supported through the University of Maryland Designated Research Initiative Fund (02-1-30678), the W.T. Grant Foundation, the Maternal and Child Health Bureau (MCH000978, MCH0654, and MCH000980), and the Agency for Health Care Policy Research (H306345).
Copyright:
Copyright 2007 Elsevier B.V., All rights reserved.
PY - 1998/4
Y1 - 1998/4
N2 - Purpose: To determine the accuracy of adolescents' self-report of health insurance coverage, using parents' report as a comparison standard. Methods: Two separate samples of urban, school-based adolescents and their parents completed self-administered questionnaires about type of health insurance coverage. Sample 1 included 123 and Sample 2 included 93 adolescent-parent pairs. Percent agreement and the kappa statistic were determined for each of the sample groups, and for males versus females and older (>14 years) versus younger (≤14 years) adolescents. Results: In Sample 1, 33% of adolescent respondents responded 'don't know' to the question about type of insurance coverage, and 4% left the question blank; in Sample 2, 3% answered 'don't know,' with none leaving the question blank. For Sample 1, we found a 57% rate of agreement of adolescents with their parents, and a corresponding kappa of .21. Females and older subjects demonstrated greater accuracy, with kappa's all in the range .13-.29. In Sample 2, 73% of subjects agreed with parents' report, with a kappa of .48. Females and older subjects also demonstrated greater accuracy, with the highest kappa of .59 demonstrated by older females. Excluding those responding with 'don't know,' we found overall percent agreement with parents of 87% in Sample 1 and 73% in Sample 2; the corresponding kappas were .47 and .51. Females demonstrated higher agreement with parents in both samples. The results stratifying by age were inconsistent. In Sample 1, privately insured subjects were more accurate reporters than those either on medical assistance or uninsured. In Sample 2, no differences were seen by type of insurance. Conclusions: Many adolescents do not know their health insurance coverage status. However, for those who did claim to know, acceptable rates of accuracy using both percent agreement and the kappa statistic were demonstrated. Further research is needed to determine how information about insurance is communicated to adolescents and how this knowledge affects access to and use of health services.
AB - Purpose: To determine the accuracy of adolescents' self-report of health insurance coverage, using parents' report as a comparison standard. Methods: Two separate samples of urban, school-based adolescents and their parents completed self-administered questionnaires about type of health insurance coverage. Sample 1 included 123 and Sample 2 included 93 adolescent-parent pairs. Percent agreement and the kappa statistic were determined for each of the sample groups, and for males versus females and older (>14 years) versus younger (≤14 years) adolescents. Results: In Sample 1, 33% of adolescent respondents responded 'don't know' to the question about type of insurance coverage, and 4% left the question blank; in Sample 2, 3% answered 'don't know,' with none leaving the question blank. For Sample 1, we found a 57% rate of agreement of adolescents with their parents, and a corresponding kappa of .21. Females and older subjects demonstrated greater accuracy, with kappa's all in the range .13-.29. In Sample 2, 73% of subjects agreed with parents' report, with a kappa of .48. Females and older subjects also demonstrated greater accuracy, with the highest kappa of .59 demonstrated by older females. Excluding those responding with 'don't know,' we found overall percent agreement with parents of 87% in Sample 1 and 73% in Sample 2; the corresponding kappas were .47 and .51. Females demonstrated higher agreement with parents in both samples. The results stratifying by age were inconsistent. In Sample 1, privately insured subjects were more accurate reporters than those either on medical assistance or uninsured. In Sample 2, no differences were seen by type of insurance. Conclusions: Many adolescents do not know their health insurance coverage status. However, for those who did claim to know, acceptable rates of accuracy using both percent agreement and the kappa statistic were demonstrated. Further research is needed to determine how information about insurance is communicated to adolescents and how this knowledge affects access to and use of health services.
KW - Accuracy
KW - Adolescents
KW - Health insurance
KW - Self-report
KW - Validity
UR - http://www.scopus.com/inward/record.url?scp=0032055827&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0032055827&partnerID=8YFLogxK
U2 - 10.1016/S1054-139X(97)00243-7
DO - 10.1016/S1054-139X(97)00243-7
M3 - Article
C2 - 9561461
AN - SCOPUS:0032055827
SN - 1054-139X
VL - 22
SP - 293
EP - 299
JO - Journal of Adolescent Health
JF - Journal of Adolescent Health
IS - 4
ER -