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Original Investigation
January 2018

Association Between Adolescent Preventive Care and the Role of the Affordable Care Act

Author Affiliations
  • 1Division of Adolescent and Young Adult Medicine, Department of Pediatrics, UCSF Benioff Children’s Hospital, University of California, San Francisco
  • 2Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
JAMA Pediatr. 2018;172(1):43-48. doi:10.1001/jamapediatrics.2017.3140
Key Points

Question  Has the provision of preventive care for adolescents, in terms of a preventive well visit and preventive services, increased since implementation of the Affordable Care Act?

Findings  This secondary data analysis of the Medical Expenditure Panel Survey, a national survey, showed that rates of preventive well visits for adolescents 10 to 17 years of age increased from 41% (2007-2009) to 48% (2012-2014). Among adolescents who received any health care visit in the past year, 8 of 9 preventive services rose, with increases ranging from 2% to 9%.

Meaning  Preventive care rates have increased moderately or modestly; however, most adolescents did not receive past-year well visits or most preventive services.


Importance  Despite decades of adolescent preventive well visit and services promotion (Guidelines for Adolescent Preventive Services and Bright Futures), rates are below recommended levels and little is known of the effect of the Patient Protection and Affordable Care Act (ACA) implementation on these care rates.

Objectives  To use Medical Expenditure Panel Survey data to determine (1) whether adolescent well visit rates increased from the pre-ACA period to post-ACA period, and (2) whether caregivers’ reports of past-year preventive services delivery increased from the pre- to post-ACA period among adolescents with any past-year health care visit.

Design, Setting, and Participants  Secondary data analysis of 2007-2009 (before ACA implementation) and 2012-2014 (after ACA implementation) Medical Expenditure Panel Survey data on the differences in well visits and preventive services. Data were collected through computer-assisted personal interviews of caregivers of a nationally representative sample of a noninstitutionalized US population (n = 25 695 10- to 17-year-old adolescents).

Main Outcomes and Measures  For objective 1, pre- to post-ACA period differences in past-year well visits: (1) stratified bivariable logistic regressions identifying subgroup rate differences and (2) multivariable analyses controlling for demographic factors. For objective 2, pre- to post-ACA period differences in caregiver reports of preventive services receipt, including time alone with clinician: (1) bivariable (year differences) and (2) multivariable logistic regressions controlling for demographic variables.

Results  A total of 6279 (50.9%) and 6730 (50.8%) participating adolescents in the pre- and post-ACA period data were male, respectively. Under objective 1, we found that well-visit rates increased from 41% to 48% post-ACA implementation (odds ratio, 1.3; 95% CI, 1.2-1.5); minority and low-income groups had the greatest increases. Under objective 2, we found that among those with any past-year visit, most preventive services rates (8 of 9) increased post-ACA implementation (range, 2%-9%, absolute), with little or no change when controlling for demographic variables. Time alone with clinicians increased 1%, significant only when covariates were controlled (adjusted odds ratio, 1.2; 95% CI, 1.0-1.3).

Conclusions and Relevance  Despite modest to moderate increases, with greatest gains for underserved youth, adolescent preventive care rates remain low, highlighting the need for increased efforts to bring adolescents into well care and improve clinician delivery of preventive care within their practices.