Healthy Young Adults: description and use of an innovative health insurance program

To evaluate enrollment patterns, healthcare use, and factors associated with enrollment in San Francisco's Healthy Young Adults (HYA) program, a comprehensive public health insurance program for young adults who age out of public insurance.

In a group of young adults who were all eligible for HYA, we compared demographic characteristics by enrollment status. Demographic information and use patterns were obtained for individuals who were continuously enrolled in HYA for 12 months.

Nearly one quarter of eligible young adults enrolled in the program. Those who enrolled were more likely to have used vision or pharmacy services in the 2 years prior to enrollment, to be Asian, and to be from Chinese-speaking families (p < .001) than those who did not enroll. The large majority (80%) of young adults who enrolled in HYA had a primary care or dental visit during the 12-month study period. More than one third (40%) of enrollees used the prescription benefit, while much smaller percentages used radiology services, the emergency department or inpatient facilities.

Young adults in the City and County of San Francisco who enrolled in HYA had high use rates. Ethnic disparities in enrollment indicate the need for targeted outreach. Adverse selection into the program, although present, was minimal. Local innovations are one way to address the problem of uninsurance in the United States, and HYA could be replicated elsewhere.