The cost of comprehensive preventive medical services for adolescents
J. E. Gans, B. Alexander, R. C. Chu and A. B. Elster
Department of Adolescent Health, American Medical Association, Chicago, Ill, USA.
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.
