Lack of health insurance among juvenile offenders: a predictor of inappropriate healthcare use and reincarceration?. (January 2019)

• Record Type: Journal Article
• Authors: Baggio, S.; Tran, N.T.; Barnert, E.S.; Gétaz, L.; Heller, P.; Wolff, H.
• Is Part Of: Public health. Volume 166(2019)
• Page Start: 25
• Page End: 33
• Publication Date: 2019-01
• Subjects: Health care -- Health insurance -- Rearrest -- Longitudinal -- Youths; Public health -- Periodicals; Public health -- Periodicals; Electronic journals; 362.1
• DOI: 10.1016/j.puhe.2018.09.029
• Languages: English
• ISSNs: 0033-3506

Abstract

Abstract: Objectives: Relationships between the health insurance status and healthcare use among justice-involved youths transitioning into adulthood is an underexplored topic, even if transition to adulthood is a crucial time period for healthcare outcomes. To fill in these knowledge gaps, this study had two aims: (1) to examine trajectories of health insurance coverage and healthcare use among serious juvenile offenders transitioning into adulthood; and (2) to explore associations between the lack of health insurance, healthcare use and reincarceration. Study design: We conducted a secondary analysis on the data of the US longitudinal Pathways to Desistance study between ages 20 and 23 years (2000–2010). Methods: Participant data on health insurance coverage, healthcare use, reincarceration and sociodemographic variables ( n = 1215) were extracted and analysed using descriptive statistics, generalized linear regressions and cross-lagged panel models. Results: About half of the young offenders had no health insurance coverage or intermittent coverage between the age of 20 and 23 years. Emergency services were used (≥17.4%), notably more by insured participants and were increasingly used over time. Being uninsured at the age of 20 years was associated with reincarceration at the age of 23 years (b = −0.052, p = 0.014, odd-ratio = 0.95), but incarceration at the age of 20 years did not predict the insurance status at the age of 23 years (b = 0.009, p = 0.792). Conclusions: Serious juvenile offenders, especially if uninsured, faced major barriers to accessing health care and often reported an inappropriate healthcare use. This likely led to reincarceration. The lack of continuity of care and of access to health care may, therefore, increase health disparities, and efforts are needed to mitigate detrimental outcomes, by effective in and out of detention coordination of health insurance coverage and among health services. Highlights: Justice-involved youths experience healthcare challenges. These challenges include being uninsured or lack of/inadequate healthcare use. A lack of health insurance may lead to detrimental outcomes such as reincarceration. Transition into adulthood is a risky period for healthcare access and use.