Young Patients as a Disruptive New Force in Healthcare

Young people typically consider themselves immune to the serious medical issues that plague older Americans, but this demographic is considerably more susceptible to mental health issues, substance abuse, pregnancy, sexually transmitted diseases and obesity than their older counterparts. Young people have grown in importance within the healthcare system since the passage of the Affordable Care Act, which enables young adults to remain on their parent's insurance plans until age 26, or secure insurance independently at subsidized rates.  A study by the Department of Health and Human Services found that almost 28 percent of the six million healthcare exchange enrollees in 2014 were between ages 19 and 34.

These 1.7 million enrollees are likely to be joined by millions more in the coming years as participation in the healthcare exchanges grows.  This new influx of young people presents new challenges to the healthcare system. A new study in the Journal of Adolescent Health found that young people exhibited certain characteristics:

• More ER visits, While young people, and young men in particular, avoided office visits, they were considerably more likely to use the emergency room.  This is related to a higher number of health emergencies, but many of these emergencies could have been avoided with routine care.
• Minorities avoid care, Compared to their Caucasian counterparts, African Americans and Hispanics used medical services considerably less often.
• Lower income patients spend more, Surprisingly, many of the most economically disadvantaged young people used more costly services like ER visits.
• Young patients more likely to recover, According to the National Cancer Institute, young people are much more likely to recover from serious cancers like those arising in colorectal, liver, prostate and breast tissue.

An unforeseen effect of health insurance has been a rise in the mental wellbeing of the insured. A study sponsored by MIT and Harvard examined the behavior of low income Oregonians who joined Medicaid in 2008.  These participants enjoyed greater rates of diabetes detection, improved peace of mind (due to less risk of catastrophic medical emergencies), and lower rates of depression.

On the other hand, health insurance does not guarantee good health.  Some have even argued that health coverage can encourage high risk behavior like faster driving, substance abuse and diminished exercise. Even age groups that are considerably more risk avoidant have been shown to engage in deleterious behavior when insured; in a 2006 study by Dhaval Dave and Robert Kaestner, men who turned 65 and joined Medicare increased risky behavior; 40% stopped or limited physical activity, 16% increased smoking and 32% increased alcohol usage. This may be extremely problematic among this young demographic which often exhibits unsupportable beliefs of invincibility.

While young people are less likely to become ill, there is still a substantial risk.  Almost one in six young people has a chronic ailment like asthma, cancer or diabetes.  Of the 129 million ER visits that occur annually, almost a quarter will involve a young person. These risks are likely to lead to sustained medical care, in addition to the routine physicals and medical care that young people will likely require. With more young people opting into the healthcare system, possibly for decades to come, this could be the most important effect of the Affordable Care Act. 

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Article written by:

Robert Moghim, M.D.

CEO, Health Carousel Locum Tenens