Military Health Care Utilization by Teens and Young Adults

Adolescents and young adults are frequently uninsured (9.0% and 26.4%). Under the Affordable Care Act, the impact of insuring this population on health care utilization is unclear. We examined insurance records from >3.5 million non-pregnancy-related primary care visits in the Military Health System to describe health care utilization patterns among 467,099 non-active duty patients, aged 12 to 22, with access to free health care. We described association of age and gender with primary care utilization rates, clinic type, and primary and secondary diagnoses. Adolescents and young adults were seen for 2.63 primary care visits per year. Use of Pediatric Clinics declined with age (51.6% to 1.8%) and increased for Family Medicine (45.5% to 91.1%). The top 3 diagnostic groups in our study were health maintenance (18.3%), health evaluation (17.3%), and respiratory/ear, nose, and throat (15.1%). Age-by-gender interactions had a significant association with health care utilization rates and diagnoses at primary care appointments. For example, the percent of all appointments accounted for by musculoskeletal injuries increased significantly (P < .001) with age for males (10.6%, 12-14 years; 12.8%, 15-18 years; 15.2%, 19-22 years) and decreased for females (10.3%, 9.2%, 7.5%). Unlike previous studies of adolescents and young adults, we show that this population, especially female young adults, does use health care when it is available and largely free. Extrapolating from our Military Health System data, we expect implementation of the Affordable Care Act will result in an increased demand for health care, particularly in the areas of reproductive health care, respiratory/ear, nose, and throat issues, and routine health maintenance.