Researchers Estimate Public Costs Associated with Restricting Teens' Access to Confidential Health Services

A study in the December issue of Archives of Pediatrics and Adolescent Medicine examines projected health consequences and public medical costs associated with restricting adolescents' access to confidential reproductive health services. Researchers focused on female teens under age 18 that depend on publicly financed health care in the state of Texas.

The reproductive health status of Texas adolescents is poor when compared to national levels. In addition, Texas recently adopted two policies that many fear may limit adolescents' access to reproductive health care. First, as of January 2003, Texas law requires parental consent for teenagers younger than 18 years to receive prescribed contraceptives. Second, a law passed in 2001 requires health care providers to report the identity of all patients younger than 17 whom they have reason to believe are sexually active to law enforcement officials because sexual contact with a person younger than 17 is a criminal offense in that state.

Proponents of mandated parental involvement contend that rules such as those adopted in Texas will decrease adolescent sexual activity and lead to a reduction in adolescent pregnancy and STDs. The authors of this study, however, disagree. They point to previous research that suggest that only one to four percent of girls indicate that they would stop having intercourse if their parents were notified. In contrast, studies show that up to 47% of girls younger than 18 would stop using all reproductive health care services if their parents were notified that they were seeking prescribed contraceptives.

For this study, researchers wanted to assess the potential economic costs that would result when adolescents do not seek reproductive health because their confidentiality is compromised.

Since both of the laws in question have not been consistently enforced in Texas, and because many health care providers are not in compliance, there is not data available on the effects of these laws. Instead, using previous data on how young people would react to parental notification, researchers constructed a model to estimate, for a one-year period, the effect of an anticipated decrease in services on pregnancies, births, abortions, and untreated STDs among girls under 18 using publicly funded reproductive health care services in Texas.

This model estimated that reporting and consent requirements would result in an additional 8,265 unintended pregnancies, 5,372 births, and 1,654 abortions among teens using publicly funded family planning clinics in Texas. In addition, these requirements would result in an additional 2,243 additional cases of untreated Chlamydia infection, 521 additional cases of untreated gonorrhea, and 501 additional cases of Pelvic Inflammatory Disease among teens using public funded family planning clinics in Texas.

According to the study these outcomes would cost $43.6 million per year, of which $33.7 million would come directly out of the pockets of Texans. The authors of the study caution, however, that these costs only account for the direct publicly funded medical expenditures such as STD screening and treatment, and prenatal care, delivery, and infant care for the first year. These figures therefore underestimate the cost to individuals and society because infants born to teen mothers often require other expenditures such as neonatal intensive care, hospitalization, public assistance, education, and special services.

The authors conclude that the potential economic costs and health consequences of laws limiting confidentiality in adolescent reproductive health care are substantial and that policymakers need to take these into account when considering such legislation.

For more information see: Luisa Franzini, et al, "Projected Economic Costs Due to Health Consequences of Teenagers' Loss of Confidentiality in Obtaining Reproductive Health Care Services in Texas," Archives of Pediatric and Adolescent Medicine 158 (2004): 1140-1146.

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