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The Cost of Comprehensive Preventive Medical Services for Adolescents

The Cost of Comprehensive Preventive Medical Services for Adolescents Abstract Objectives: To address the need for clinical preventive services for 11- to 21-year-old males and females and provide cost estimates for those services under a fee-forservice system. Preventive services include screening, health promotion, and immunizations. Design: The prevalence of adolescent morbidities was derived from national surveys. Estimated costs of these morbidities were obtained from published data and adjusted for 1992 dollars using the Consumer Price Index. The estimated costs of preventive services for adolescents under a fee-for-service system were derived from a 1993 survey of nine Blue Cross and Blue Shield plans and four insurance companies. Main Outcome Measures: The cost of adolescent morbidities includes only direct medical costs for a single year and excludes long-term and indirect costs. The cost of clinical preventive services is calculated at 100% participation levels. Results: Each year, an estimated $33.5 billion is spent on medical treatment for select adolescent morbidities, approximately $859 per adolescent per year; this is a conservative estimate. The average cost of clinical preventive services per adolescent per year would be approximately $130 in a fee-for-service system, although these are not entirely "new" costs because payers already incur screening costs for some conditions. Conclusion: The cost-effectiveness of clinical interventions for various health risk behaviors among adolescents is unknown. It appears that preventive interventions would have to eliminate 15% of adolescent morbidities overall to break even in economic terms.(Arch Pediatr Adolesc Med. 1995;149:1226-1234) References 1. Clinton Administration. Health Security Act . Washington, DC: Government Printing Office; 1993. 2. Gans JE, McManus MA, Newacheck PW. Adolescent Health Care: Use, Costs, and Problems of Access . Chicago, Ill: American Medical Association; 1991:2. The AMA Profiles of Adolescent Health Series. 3. Braveman P, Toomey KE. Screening in preventive care for adolescents . West J Med . 1987;146:490-493. 4. Klein JD, McAnarney ER. Adolescent medicine . JAMA . 1993;270:186-188.Crossref 5. Pentz MA, Cormack C, Flay B, Hansen WB, Johnson A. Balancing program and research integrity in community drug abuse prevention: Project STAR approach . J Sch Health . 1986;56:389-393.Crossref 6. Pentz MA, MacKinnon DM, Flay BR, Hansen WB, Johnson CA, Dwyer JH. Primary prevention of chronic diseases in adolescence: effects of the Midwestern Prevention Project (MPP) on Tobacco Use . Am J Epidemiol . 1989;130:781-794. 7. Vartianinen E, Fallonen U, McAllister AL, Puska K. Eight year follow-up results of an adolescent smoking prevention program: The North Karelia Youth Project . Am J Public Health . 1990;80:78-79.Crossref 8. Emmet ST, Tobler NS, Ringwalt CL, Flewelling RL. How effective is drug abuse resistance education? a meta-analysis of Project DARE outcome evaluations . Am J Public Health . 1994;84:1394-1401.Crossref 9. Elder JP, Wildey M, de Moor C, et al. The long-term prevention of tobacco use among junior high school students: classroom and telephone interventions . Am J Public Health . 1993;83:1239-1244.Crossref 10. Hansen WB, Johnson A, Flay BR, Graham JW, Sobel J. Affective and social influences approaches to the prevention of multiple substance abuse among seventh grade students: results from Project SMART . Prev Med . 1988;17:135-154.Crossref 11. Brindis C, Jeremy R. Adolescent Pregnancy and Parenting in California: A Strategic Plan for Action . San Francisco, Calif: University of California, San Francisco; 1988. 12. Zabin LS, Hirsch MB, Streett R, et al. The Baltimore Pregnancy Prevention Program for urban teenagers: how did it work? Fam Plann Perspect . 1988; 20:182-187.Crossref 13. Schinke S, Jansen M, Kennedy E, Shi Q. Reducing risk-taking behavior among vulnerable youth: an intervention outcome study . Fam Community Health . 1994; 16:49-56.Crossref 14. Prothrow-Stith D, Weissman M. Deadly Consequences: How Violence is Destroying Our Teenage Population and a Plan to Begin Solving the Problem . New York, NY: Harper & Row Publishers Inc; 1991. 15. Sussman S, Dent CW, Stacy AW, Hodgson CS, Burton D, Flay BR. Project Toward No Tobacco Use: implementation, process, and post-test knowledge evaluation . Health Educ Res . 1993;8:49-56.Crossref 16. Pentz MA, Cormack C, Flay B, Hansen WB, Johnson CA. Balancing program and research integrity in community drug abuse prevention: Project STAR approach . J School Health . 1986;56:389-393.Crossref 17. Erickson PI. Lessons from a repeat pregnancy prevention program for Hispanic teenage mothers in east Los Angeles . Fam Plann Perspect . 1994;26: 174-178.Crossref 18. Kipke MD, Boyer C, Hein K. An evaluation of an AIDS risk reduction education and skills training (ARREST) program . J Adolesc Health . 1993:14:533-539.Crossref 19. Pentz, MA. Benefits of integrating strategies in different settings . In: Elster AB, Panzarine S, Holt K, eds. American Medical Association State-of-the-Art Conference on Adolescent Health Promotion: Proceedings . Arlington, Va: National Center for Education in Maternal and Child Health; 1993:15-33. 20. Dryfoos JG. Adolescents at risk: a summation of work in the field: programs and policies . J Adolesc Health . 1991;12:630-637.Crossref 21. Green M, ed. Bright Futures: Guidelines for Health Supervision of Infants. Children, and Adolescents . Arlington, Va: National Center for Education in Maternal and Child Health; 1994. 22. US Preventive Services Task Force. Guide to Clincial Preventive Services: An Assessment of 169 Interventions . Baltimore, Md: Williams & Wilkins; 1989. 23. Elster AB. New initiatives in adolescent health promotion . AJDC . 1991:145: 495-496. 24. American Medical Association. Guidelines for Adolescent Preventive Services . Chicago, III: American Medical Association; 1992. 25. Elster AE, Kuznets NJ. AMA Guidelines for Adolescent Preventives Services: Recommendations and Rationale . Baltimore, Md: Williams & Wilkins. 1994. 26. Kottke TE, Battista RN, DeFriese GH, Brekke ML. Attributes of successful smoking cessation interventions in medical practice: a meta-analysis of 39 controlled trials . JAMA . 1988:259:2883-2889.Crossref 27. US Department of Labor, Bureau of Labor Statistics. Consumer Price Index Detailed Report . Washington, DC: Superintendent of Documents; 1993. 28. Congressional Research Service. Insuring the Uninsured: Options and Analysis . Washington, DC: Congressional Research Service; (October) 1988:46. 29. National Cholesterol Education Program. Report of the expert panel on blood cholesterol levels in children and adolescents . Pediatrics . 1992;89( (suppl) ):525-584. 30. Sonnenstein FL, Pleck JH, Ku LC. Levels of sexual activity among adolescent males in the United States . Fam Plann Perspect . 1991;23:162-167.Crossref 31. Centers for Disease Control and Prevention. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP) . MMWR . 1994;43:1-38. 32. American Academy of Pediatrics. Report of the Committee on Infectious Diseases of the American Academy of Pediatrics, 1991 . Elk Grove Village, III: American Academy of Pediatrics; 1991. 33. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report . Atlanta, Ga: Centers for Disease Control and Prevention; (October) 1992:1-18. 34. Howard M. Delaying the start of intercourse among adolescents . In: Coupey SM, Klerman LV, eds. Adolescent Medicine: State-of-the-Art Reviews . Philadelphia, Pa: Hanley & Belfus; 1992;3:181-193. 35. Morris NM. Determinants of adolescent initiation of coitus . In Coupey SM, Klerman LV, eds. Adolescent Medicine: State-of-the-Art Reviews . Philadelphia, Pa: Hanley & Belfus; 1992;3:165-180. 36. Forrest JD, Singh S. The sexual and reproductive behavior of American women, 1982-1988 . Fam Plann Perspect . 1990;22:206-214.Crossref 37. Centers for Disease Control and Prevention. Sexual behavior among high school students: United States, 1990 . Chronic Disease and Health Promotion MMWR Reprints, 1990 Youth Risk Behavior Surveillance System . Atlanta, Ga: Centers for Disease Control and Prevention; 1990:29-31. 38. Henshaw SK, Van Vort J. Abortion Factbook: 1992 Edition: Readings, Trends, and State and Local Data to 1988 . New York, NY: The Alan Guttmacher Institute; 1992. 39. Koonin LM, Kochanek KD, Smith JC, Ramick M. Abortion surveillance, United States, 1988 . MMWR Morb Mortal Wkly Rep . 1992;40:15-42. 40. Henshaw SK. The accessibility of abortion services in the United States . Fam Plann Perspect . 1991;23:246-253.Crossref 41. Hughes D, Johnson K, Rosenbaum S, Butler E, Simons J. The Health of America's Children: Maternal and Child Health Data Book . Washington, DC: Children's Defense Fund; 1988. 42. US House of Representatives Select Committee on Children, Youth, and Families. Opportunities for Success: Cost Effective Programs for Children . Washington, DC: US Government Printing Office; (August 14) , 1985. 43. National Center for Health Statistics. Vital Statistics of the United States, 1989 . Washington, DC: US Public Health Service; 1989;1. 44. National Center for Health Statistics. Advanced report of final natality statistics, 1988 . In: Monthly Vital Statistics Report . Hyattsville, Md: National Center for Health Statistics; 1990;40( (suppl) ):28. Dept of Health and Human Services publication 90-1120. 45. US Congress Office of Technology Assessment. Neonatal Intensive Care for Low Birthweight Infants: Costs and Effectiveness . Washington, DC: US Government Printing Office; 1987. Health Technology Case Study No. 38, publication OTA-HCS-38. 46. Health Insurance Association of America. Source Book of Health Insurance Data, 1990 . Washington, DC: Health Insurance Association of America; 1990. 47. National Center for Health Statistics. Advance report of new data from the 1989 birth certificate . Monthly Vital Statistics Report . Hyattsville, Md: National Center for Health Statistics; 1992:40:23. 48. Hellinger F. Forecasts of the costs of medical care for persons with HIV: 1992-1995 . Inquiry . 1992;29:356-365. 49. Noble J. Reimbursement for adolescent alcohol, drug abuse, and mental health treatment. Presented at the Conference on Treatment of Adolescents With Alcohol, Drug Abuse, and Mental Health Problems; October 2-4,1989; Alexandria, Va. 50. Rice DM, MacKenzie EJ, and Associates. Cost of Injury in the United States: A Report to Congress, 1989 . San Francisco, Calif: Institute for Health & Aging, University of California; 1989. 51. US Congress Office of Technology Assessment. Adolescent Health: Background and the Effectiveness of Selected Prevention and Treatment Services . Washington, DC: US Government Printing Office; 1991;2:II-469. Publication OTA-H-466. 52. National Coordinating Committee on Clinical Preventive Services. Preventive Services in the Clinical Setting: What Works and What It Costs . Washington, DC: US Public Health Service; (May) 1993. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Pediatrics & Adolescent Medicine American Medical Association

The Cost of Comprehensive Preventive Medical Services for Adolescents

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
1072-4710
eISSN
1538-3628
DOI
10.1001/archpedi.1995.02170240044007
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Abstract

Abstract Objectives: To address the need for clinical preventive services for 11- to 21-year-old males and females and provide cost estimates for those services under a fee-forservice system. Preventive services include screening, health promotion, and immunizations. Design: The prevalence of adolescent morbidities was derived from national surveys. Estimated costs of these morbidities were obtained from published data and adjusted for 1992 dollars using the Consumer Price Index. The estimated costs of preventive services for adolescents under a fee-for-service system were derived from a 1993 survey of nine Blue Cross and Blue Shield plans and four insurance companies. Main Outcome Measures: The cost of adolescent morbidities includes only direct medical costs for a single year and excludes long-term and indirect costs. The cost of clinical preventive services is calculated at 100% participation levels. Results: Each year, an estimated $33.5 billion is spent on medical treatment for select adolescent morbidities, approximately $859 per adolescent per year; this is a conservative estimate. The average cost of clinical preventive services per adolescent per year would be approximately $130 in a fee-for-service system, although these are not entirely "new" costs because payers already incur screening costs for some conditions. Conclusion: The cost-effectiveness of clinical interventions for various health risk behaviors among adolescents is unknown. It appears that preventive interventions would have to eliminate 15% of adolescent morbidities overall to break even in economic terms.(Arch Pediatr Adolesc Med. 1995;149:1226-1234) References 1. Clinton Administration. Health Security Act . Washington, DC: Government Printing Office; 1993. 2. Gans JE, McManus MA, Newacheck PW. Adolescent Health Care: Use, Costs, and Problems of Access . Chicago, Ill: American Medical Association; 1991:2. The AMA Profiles of Adolescent Health Series. 3. Braveman P, Toomey KE. Screening in preventive care for adolescents . West J Med . 1987;146:490-493. 4. Klein JD, McAnarney ER. Adolescent medicine . JAMA . 1993;270:186-188.Crossref 5. Pentz MA, Cormack C, Flay B, Hansen WB, Johnson A. Balancing program and research integrity in community drug abuse prevention: Project STAR approach . J Sch Health . 1986;56:389-393.Crossref 6. Pentz MA, MacKinnon DM, Flay BR, Hansen WB, Johnson CA, Dwyer JH. Primary prevention of chronic diseases in adolescence: effects of the Midwestern Prevention Project (MPP) on Tobacco Use . Am J Epidemiol . 1989;130:781-794. 7. Vartianinen E, Fallonen U, McAllister AL, Puska K. Eight year follow-up results of an adolescent smoking prevention program: The North Karelia Youth Project . Am J Public Health . 1990;80:78-79.Crossref 8. Emmet ST, Tobler NS, Ringwalt CL, Flewelling RL. How effective is drug abuse resistance education? a meta-analysis of Project DARE outcome evaluations . Am J Public Health . 1994;84:1394-1401.Crossref 9. Elder JP, Wildey M, de Moor C, et al. The long-term prevention of tobacco use among junior high school students: classroom and telephone interventions . Am J Public Health . 1993;83:1239-1244.Crossref 10. Hansen WB, Johnson A, Flay BR, Graham JW, Sobel J. Affective and social influences approaches to the prevention of multiple substance abuse among seventh grade students: results from Project SMART . Prev Med . 1988;17:135-154.Crossref 11. Brindis C, Jeremy R. Adolescent Pregnancy and Parenting in California: A Strategic Plan for Action . San Francisco, Calif: University of California, San Francisco; 1988. 12. Zabin LS, Hirsch MB, Streett R, et al. The Baltimore Pregnancy Prevention Program for urban teenagers: how did it work? Fam Plann Perspect . 1988; 20:182-187.Crossref 13. Schinke S, Jansen M, Kennedy E, Shi Q. Reducing risk-taking behavior among vulnerable youth: an intervention outcome study . Fam Community Health . 1994; 16:49-56.Crossref 14. Prothrow-Stith D, Weissman M. Deadly Consequences: How Violence is Destroying Our Teenage Population and a Plan to Begin Solving the Problem . New York, NY: Harper & Row Publishers Inc; 1991. 15. Sussman S, Dent CW, Stacy AW, Hodgson CS, Burton D, Flay BR. Project Toward No Tobacco Use: implementation, process, and post-test knowledge evaluation . Health Educ Res . 1993;8:49-56.Crossref 16. Pentz MA, Cormack C, Flay B, Hansen WB, Johnson CA. Balancing program and research integrity in community drug abuse prevention: Project STAR approach . J School Health . 1986;56:389-393.Crossref 17. Erickson PI. Lessons from a repeat pregnancy prevention program for Hispanic teenage mothers in east Los Angeles . Fam Plann Perspect . 1994;26: 174-178.Crossref 18. Kipke MD, Boyer C, Hein K. An evaluation of an AIDS risk reduction education and skills training (ARREST) program . J Adolesc Health . 1993:14:533-539.Crossref 19. Pentz, MA. Benefits of integrating strategies in different settings . In: Elster AB, Panzarine S, Holt K, eds. American Medical Association State-of-the-Art Conference on Adolescent Health Promotion: Proceedings . Arlington, Va: National Center for Education in Maternal and Child Health; 1993:15-33. 20. Dryfoos JG. Adolescents at risk: a summation of work in the field: programs and policies . J Adolesc Health . 1991;12:630-637.Crossref 21. Green M, ed. Bright Futures: Guidelines for Health Supervision of Infants. Children, and Adolescents . Arlington, Va: National Center for Education in Maternal and Child Health; 1994. 22. US Preventive Services Task Force. Guide to Clincial Preventive Services: An Assessment of 169 Interventions . Baltimore, Md: Williams & Wilkins; 1989. 23. Elster AB. New initiatives in adolescent health promotion . AJDC . 1991:145: 495-496. 24. American Medical Association. Guidelines for Adolescent Preventive Services . Chicago, III: American Medical Association; 1992. 25. Elster AE, Kuznets NJ. AMA Guidelines for Adolescent Preventives Services: Recommendations and Rationale . Baltimore, Md: Williams & Wilkins. 1994. 26. Kottke TE, Battista RN, DeFriese GH, Brekke ML. Attributes of successful smoking cessation interventions in medical practice: a meta-analysis of 39 controlled trials . JAMA . 1988:259:2883-2889.Crossref 27. US Department of Labor, Bureau of Labor Statistics. Consumer Price Index Detailed Report . Washington, DC: Superintendent of Documents; 1993. 28. Congressional Research Service. Insuring the Uninsured: Options and Analysis . Washington, DC: Congressional Research Service; (October) 1988:46. 29. National Cholesterol Education Program. Report of the expert panel on blood cholesterol levels in children and adolescents . Pediatrics . 1992;89( (suppl) ):525-584. 30. Sonnenstein FL, Pleck JH, Ku LC. Levels of sexual activity among adolescent males in the United States . Fam Plann Perspect . 1991;23:162-167.Crossref 31. Centers for Disease Control and Prevention. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP) . MMWR . 1994;43:1-38. 32. American Academy of Pediatrics. Report of the Committee on Infectious Diseases of the American Academy of Pediatrics, 1991 . Elk Grove Village, III: American Academy of Pediatrics; 1991. 33. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report . Atlanta, Ga: Centers for Disease Control and Prevention; (October) 1992:1-18. 34. Howard M. Delaying the start of intercourse among adolescents . In: Coupey SM, Klerman LV, eds. Adolescent Medicine: State-of-the-Art Reviews . Philadelphia, Pa: Hanley & Belfus; 1992;3:181-193. 35. Morris NM. Determinants of adolescent initiation of coitus . In Coupey SM, Klerman LV, eds. Adolescent Medicine: State-of-the-Art Reviews . Philadelphia, Pa: Hanley & Belfus; 1992;3:165-180. 36. Forrest JD, Singh S. The sexual and reproductive behavior of American women, 1982-1988 . Fam Plann Perspect . 1990;22:206-214.Crossref 37. Centers for Disease Control and Prevention. Sexual behavior among high school students: United States, 1990 . Chronic Disease and Health Promotion MMWR Reprints, 1990 Youth Risk Behavior Surveillance System . Atlanta, Ga: Centers for Disease Control and Prevention; 1990:29-31. 38. Henshaw SK, Van Vort J. Abortion Factbook: 1992 Edition: Readings, Trends, and State and Local Data to 1988 . New York, NY: The Alan Guttmacher Institute; 1992. 39. Koonin LM, Kochanek KD, Smith JC, Ramick M. Abortion surveillance, United States, 1988 . MMWR Morb Mortal Wkly Rep . 1992;40:15-42. 40. Henshaw SK. The accessibility of abortion services in the United States . Fam Plann Perspect . 1991;23:246-253.Crossref 41. Hughes D, Johnson K, Rosenbaum S, Butler E, Simons J. The Health of America's Children: Maternal and Child Health Data Book . Washington, DC: Children's Defense Fund; 1988. 42. US House of Representatives Select Committee on Children, Youth, and Families. Opportunities for Success: Cost Effective Programs for Children . Washington, DC: US Government Printing Office; (August 14) , 1985. 43. National Center for Health Statistics. Vital Statistics of the United States, 1989 . Washington, DC: US Public Health Service; 1989;1. 44. National Center for Health Statistics. Advanced report of final natality statistics, 1988 . In: Monthly Vital Statistics Report . Hyattsville, Md: National Center for Health Statistics; 1990;40( (suppl) ):28. Dept of Health and Human Services publication 90-1120. 45. US Congress Office of Technology Assessment. Neonatal Intensive Care for Low Birthweight Infants: Costs and Effectiveness . Washington, DC: US Government Printing Office; 1987. Health Technology Case Study No. 38, publication OTA-HCS-38. 46. Health Insurance Association of America. Source Book of Health Insurance Data, 1990 . Washington, DC: Health Insurance Association of America; 1990. 47. National Center for Health Statistics. Advance report of new data from the 1989 birth certificate . Monthly Vital Statistics Report . Hyattsville, Md: National Center for Health Statistics; 1992:40:23. 48. Hellinger F. Forecasts of the costs of medical care for persons with HIV: 1992-1995 . Inquiry . 1992;29:356-365. 49. Noble J. Reimbursement for adolescent alcohol, drug abuse, and mental health treatment. Presented at the Conference on Treatment of Adolescents With Alcohol, Drug Abuse, and Mental Health Problems; October 2-4,1989; Alexandria, Va. 50. Rice DM, MacKenzie EJ, and Associates. Cost of Injury in the United States: A Report to Congress, 1989 . San Francisco, Calif: Institute for Health & Aging, University of California; 1989. 51. US Congress Office of Technology Assessment. Adolescent Health: Background and the Effectiveness of Selected Prevention and Treatment Services . Washington, DC: US Government Printing Office; 1991;2:II-469. Publication OTA-H-466. 52. National Coordinating Committee on Clinical Preventive Services. Preventive Services in the Clinical Setting: What Works and What It Costs . Washington, DC: US Public Health Service; (May) 1993.

Journal

Archives of Pediatrics & Adolescent MedicineAmerican Medical Association

Published: Nov 1, 1995

References