EXECUTIVE SUMMARY

Research published by the Centers for Disease Control and Prevention indicates that one of every eight sexually experienced teenagers and young adults who are on their parents’ health insurance plan said they would not go for healthcare advice related to sexual or reproductive issues because their parents might find out.

  • Changes in the U.S. healthcare system now allow a dependent child to stay on a parent’s health insurance plan until the child’s 26th birthday. These same changes call for coverage of certain preventive services, including some sexually transmitted disease services, without cost sharing for most plans.
  • While these changes may have expanded access to services, some teens and young adults may delay or refrain from seeking services due to concerns about confidentiality, including the fear that their parents might learn about their care.

Research published by the Centers for Disease Control and Prevention (CDC) indicates that one of every eight teenagers and young adults who are sexually experienced and on their parents’ health insurance plan said they would not go for sexual or reproductive healthcare advice because their parents might find out.1

Changes in the U.S. healthcare system now allow a dependent child to stay on a parent’s health insurance plan until the child’s 26th birthday. These same changes call for coverage of certain preventive services, including some sexually transmitted disease (STD) services, without cost sharing for most plans.2 While these changes may have expanded access to services, some teens and young adults may delay or refrain from seeking services due to concerns about confidentiality, including the fear that their parents might learn about their care.3

CDC researchers looked at data from the 2013-2015 National Survey of Family Growth, which gathers information on family life, marriage, divorce, pregnancy, infertility, use of birth control, and men’s and women’s health. Their analysis indicates that 12.7% of sexually experienced adolescents ages 15-17 and young adults ages 18-25 who were on a parent’s insurance plan would not access sexual and reproductive healthcare because of concerns surrounding confidentiality. Teens ages 15-17 (22.6%) were particularly concerned, data indicate.

Findings suggest that female respondents who had confidentiality concerns were less inclined to be screened for chlamydia (17.1%), compared to those who were not (38.7%).1

Previous research has suggested confidentiality may serve as a barrier to accessing STD testing and treatment services, notes Jami Leichliter, PhD, a research behavioral scientist in the CDC’s Division of STD Prevention. In recent years, budget reductions for state and local STD programs and nationwide increases of chlamydia, gonorrhea, and syphilis underscore the importance of ensuring young people, the age group most affected by STDs, have the tools and resources they need to protect themselves from STDs, says Leichliter, lead author of the research paper.

“Our analysis sought to assess whether concerns around confidentiality are impacting young people’s decision to seek STD services, particularly in a time when changes to the healthcare system have increased the insured population,” says Leichliter.

Check the Data

In the current paper, data were collected primarily using audio computer-assisted self-interviewing. Researchers looked at teens and young adults ages 15-25 who were sexually experienced, which was defined as ever having had any type of sexual contact with an opposite-sex or same-sex partner. Respondents under a parent’s health plan were questioned about whether they would not seek sexual/reproductive services due to their parents’ knowledge of such services. Those ages 15-17 were asked if they had had time alone with a healthcare provider in the past 12 months without a parent, relative, or guardian in the room. Respondents were identified as having a sexual risk assessment if they indicated that a healthcare provider or doctor had asked them about at least one of these items: sexual orientation or sex of their sexual partners; number of sexual partners; use of condoms; and types of sex. The receipt of other STD services was defined for females as receiving a chlamydia test in the past 12 months; for males, receipt of services included receiving an STD test in the past 12 months; and for females and males, this was defined as receiving treatment for an STD in the past 12 months.

The analysis shows that teens ages 15-17 who reported having time alone with a healthcare provider in the past 12 months indicated prevalences of receiving a sexual risk assessment (71.1%) that were significantly higher than those who did not have time alone with a healthcare provider (36.6%). Teens ages 15-17 who had time alone with a healthcare provider were more likely to have received a chlamydia test in the past 12 months (34.0%) than were those who had not had time alone with a healthcare provider (14.9%).

For young men ages 15-25, there was little difference in the reported prevalence of receiving an STD test in the past 12 months in those who would not seek out sexual and reproductive healthcare because their parents might learn about it (13.0%) compared with those who would seek out that healthcare advice (16.7%). Also, the prevalence did not fluctuate among male teens ages 15-17 who had time alone with a healthcare provider in the past 12 months (13.6%) and those who did not (9.5%).1

What’s Your Role?

According to the Guttmacher Institute, all U.S. states and the District of Columbia allow all minors to consent to STD services. Eighteen of these states allow, but do not require, a physician to notify a minor’s parents that he or she is seeking or receiving STD services when the doctor determines that it is in the minor’s best interests. These 18 states are Alabama, Arkansas, Delaware, Georgia, Hawaii, Illinois, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Minnesota, Missouri, Montana, New Jersey, Oklahoma, and Texas. (Check other minor rights at: http://bit.ly/2sApTK4.)

The Society for Adolescent Health and Medicine, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists are in agreement in their stance that clinicians should be able to provide confidential health services to consenting adolescents and young adults who have insurance through their parents’ coverage.4 These services include care related to STIs, birth control, pregnancy, substance use or abuse, and mental health.4

Several states now have provisions to address confidentiality in private healthcare billing and insurance claims. These provisions include identifying situations in which explanation of benefits (EOBs) do not have to be sent (for example, when there is no balance due from the policy holder); sending EOBs regarding sensitive services to the patient directly at an address that is specified by the patient, and using minor consent laws to specify that the care to which a minor can consent must be confidential, including in the process of healthcare billing.4

It is essential to protect confidentiality in healthcare billing and insurance claims in providing healthcare for adolescents and young adults, according to the consensus statement. Clinicians must be able to provide confidential healthcare services to adolescents and young adults who are covered as dependents under a family’s health insurance plan, the organizations agree.

REFERENCES

  1. Leichliter JS, Copen C, Dittus PJ. Confidentiality issues and use of sexually transmitted disease services among sexually experienced persons aged 15-25 years — United States, 2013-2015. MMWR Morb Mortal Wkly Rep 2017;66:237-241.
  2. Fox JB, Shaw FE. Clinical preventive services coverage and the Affordable Care Act. Am J Public Health 2015;105:e7-10.
  3. Ford CA, Best D, Miller WC. The pediatric forum: Confidentiality and adolescents’ willingness to consent to sexually transmitted disease testing. Arch Pediatr Adolesc Med 2001;155:1072-1073.
  4. Confidentiality protections for adolescents and young adults in the health care billing and insurance claims process. Pediatrics 2016; doi:10.1542/peds.2016-0593.