This research proposal examines the health care challenges facing uninsured and underinsured adolescents and young adults in the United States. Drawing on existing literature, the paper identifies barriers to preventive care, the consequences of emergency room dependency, and the role of public insurance programs such as Medicaid and SCHIP. The study proposes a phenomenological qualitative design, collecting data through semi-structured interviews with professionals who work directly with uninsured and underinsured youth. The paper argues that underinsurance constitutes a form of health care poverty, and that amplifying minority and unique voices is essential to fully understanding this population's unmet needs.
Early intervention and preventive care for health problems and medical issues that youth experience have the potential to improve adolescents' physical and mental health, as well as reduce death and illness among young people. Amid contemporary, challenging, and rising costs for medical services, however, some Americans at times feel forced to choose whether to secure non-emergency medical care for the youth in their family or spend money on food, clothing, shelter, and other necessities. As a result, a number of young people's health needs may go undiagnosed and untreated. Over time, that lack of attention to potential problems and illnesses may adversely affect a youth's long-term health (Health Policy Reform Beyond, 2008).
Because numerous adolescent health problems prove to be serious, costly, and widespread — including sexually transmitted infections, unintended pregnancy, and substance use — prevention and primary care services constitute particularly critical issues for this population. In "The Uninsured: A Forgotten Population," C. Galambos (2005) describes a number of issues that arise when a member of America's "forgotten population," regardless of age, does not have health insurance. Consequences include the uninsured not receiving regular routine medical care and frequently utilizing emergency services for treatment. In fact, uninsured individuals are four times more likely to use the Emergency Room (ER) as a regular source of medical care than individuals with insurance. The practice of not securing routine medical treatment outside the ER proves costly in both monetary and medical terms. When the country's youth do not receive regular medical care, costs are incurred not only in the present but may also lead to costly future consequences.
In response to a number of concerns and challenges relating to this contemporary issue, this study proposes to explore the area and identify and describe particular, pertinent issues relating to uninsured and underinsured youth who live in the United States.
Josephine Ensign (2004), who explores youth-related insurance concerns in "Quality of Health Care: The Views of Homeless Youth," reports that adolescents — including young adults — represent the group most likely to be uninsured or underinsured in the U.S. The lack of insurance coverage can adversely affect children's health, as they are less likely to receive preventive health and medical care. Because health insurance serves as a vital tool that provides youth access to crucial health services, this study will identify and describe the issues affecting uninsured and underinsured youth.
For any investigation, according to M. Dereshiwsky (1999) in "Electronic Textbook — Let Us Count the Ways: Strategies for Doing Qualitative Research," the research question or questions constitute the study's heart and soul. The following research questions will also help ensure the researcher's focus remains intact throughout the process:
1. What attitudes, beliefs, and policy considerations currently contribute to the issues relating to uninsured and underinsured youth?
2. What issues evolve from youth being uninsured and underinsured?
3. What practices and/or actions could reduce the number of uninsured and underinsured youth in the U.S.?
The researcher's knowledge of the phenomenon being identified and described during the study is currently at the beginning of the exploratory stage. With the approval of this proposal, the researcher plans to begin more substantive work in the explanatory phase of the study.
L. Raiz (2006) points out in "Health Care Poverty" that, due to different definitions and measurements, underinsurance — similar to uninsurance — proves challenging because it can constitute an insurmountable obstacle for countless individuals in the U.S. Being underinsured, Raiz contends, could be considered a form of health care poverty. Rather than existing within a simple insured-or-uninsured binary, the problem is far more expansive, and if not countered with positive measures, the health care poverty of youth will expand and affect even more victims.
Along with exhibiting poor patterns of preventive primary health care, Ensign (2004) notes, adolescents traditionally experience unique barriers to accessing appropriate health care. Barriers that adolescents face include confusion regarding the legal right to consent to their own care, concerns over the confidentiality of care, conflicting office hours, and unease with conventional adult-oriented health care settings. Out of all age groups in the U.S., adolescents — including young adults — represent the individuals most likely to be uninsured or underinsured.
In "Health Insurance for Children: Analysis and Recommendations," E. M. Lewit, C. Bennett, and R. E. Behrman (2003) confirm the need for additional outreach efforts to increase youth participation in Medicaid and SCHIP. As they write, "The public investment in children's health insurance reflects both a national commitment to protect children's health and the social value that Americans place on children's well-being" (Lewit, Bennett, & Behrman, 2003, ¶ 3). Although a number of factors in youth's physical and social environments influence their health and well-being, health insurance serves as a vital tool that provides youth access to crucial health services. States need to closely monitor the programs responsible for providing insurance, Lewit, Bennett, and Behrman stress, as well as whether those programs meet adolescents' medical and insurance needs.
According to A. Weil (2007) in "A Health Plan to Reduce Poverty," even though approximately all children in families with incomes under 200% of the poverty level qualify for Medicaid or the State Children's Health Insurance Program (SCHIP), the parents of poor children frequently do not have health insurance themselves. After parents leave welfare, they usually receive a year of coverage, but they lose this coverage unless their employer provides it. Many employers of low-wage workers, however, do not offer health insurance. The lack of parental coverage may also adversely affect the health of children, as adults without health insurance may be less likely to ensure their children receive preventive health and medical care.
"Phenomenological qualitative design with purposive sampling"
"Semi-structured interviews with youth-serving professionals"
Regarding the phenomenon being researched, as Groenewald (2004) stresses, the unique or minority voices prove to be vital counterpoints for the researcher to bring out. During the course of the proposed study, as the researcher identifies and describes the issues that uninsured and underinsured youth must contend with, the unique and/or minority voices of a number of these youth will be conveyed through accounts by the professionals who care for them.
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