The cost of comprehensive preventive medical services for adolescents.

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-for-service 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.

Choice of research setting in understanding adolescent health problems.

PURPOSE: This paper describes key features of settings in which most adolescent health research is done, advantages and disadvantages of each setting, crosscutting issues to consider in every setting, and strategies for overcoming common problems in adolescent research. METHODS: Thirty experts in adolescent health research were interviewed. They described advantages and disadvantages of doing research in particular settings or with particular populations, strategies for gaining access to research settings and conducting health research on adolescents, and suggestions for those planning to do research in a specific setting. RESULTS: Schools and households are the preferred settings for research about normative adolescent health issues, though underreporting may be more common in household samples. Households are typically used for longitudinal studies. Candid reporting of sensitive or deviant behavior may be improved in clinical settings where confidentiality can be guaranteed, but data collection may be protracted and sample biases may not be evident. Juvenile justice facilities, inpatient psychiatric hospitals, and community agencies are good settings for studying youth with serious or multiple problems. CONCLUSIONS: The choice of setting should be appropriate for the research questions posed. Concerns of the organization in which the research will be done and benefits from the proposed research should be addressed. Confidentiality must be assured and precautions for protection of human subjects must be observed. Innovative approaches must be used to recruit special populations, and adolescents should participate in the research design. Researchers should leave good feelings in their wake once research has ended.