A substantial percentage of young adults are not interacting with healthcare, potentially missing out on early interventions that could promote better health in later life, according to experts.

Approximately half of young adults decide when they need a healthcare visit and schedule that visit themselves, according to results of a new survey conducted by Ipsos Public Affairs for C.S. Mott Children’s Hospital National Poll on Children’s Health at the University of Michigan in Ann Arbor, Michigan.

“We see a lot of well-meaning parents who manage aspects of their children’s lives long after that child is old enough to take on responsibility,” said Sarah Clark, MPH, co-director of the C.S. Mott Children’s Hospital National Poll on Children’s Health and a research scientist in the Department of Pediatrics at the University of Michigan.

“Historically, turning 18 brought multiple milestones, including not only the ability to oversee one’s health, but the necessity to take charge of it,” said William Callahan, DO, a family medicine physician at Jefferson Health in Jenkintown, Pennsylvania, who was not involved in the survey. “Prior to 2010, young adults typically aged out of their parents’ health insurance policies upon graduating from high school or college, which meant that, out of necessity, young adults had to learn how to navigate insurance networks, choose a primary care provider, and manage their own care, all between the ages of 18 and 23 years,” Callahan said.

Following the passage of the Affordable Care Act (ACA) in 2010, young adults can remain on a parent’s health insurance plan until age 26 years. “While this provided a financial safety net for young adults, it also deferred the historic rite of independent passage into the healthcare system, and recent data suggest this may have inadvertently fostered a system-wide disengagement,” Callahan noted.

The survey was conducted in a randomly selected group of 1550 parents in the US with at least one child aged 18-25 years living in their home. Approximately 1 in 6 parents (17%) responded that their adult children handle none of six basic healthcare tasks: communicating with providers during a visit, following providers’ instructions after visits, arranging transportation to appointments, providing information about insurance and family history, scheduling appointments, and deciding when healthcare appointments are needed.

Most parents reported that their adult child communicates with healthcare providers during a visit and follows providers’ instructions (71% for both). In addition, 69%, 56%, 52%, and 49% of parents, respectively, said their child arranges transportation to appointments, provides family history and insurance information, schedules appointments, and decides that appointments are needed.

Overall, 53% of parents rated themselves as excellent or very good at preparing their young adult child to handle healthcare on their own. Parents were more likely to cite lack of healthcare knowledge as a barrier for their children (27%) than lack of maturity (16%).

Insurance Issues and Implications

When young adults remain on their parents’ health insurance, parents often continue to do the paperwork, Clark said. “For young adults, while it’s great that they can maintain insurance coverage, they miss an opportunity to learn about the healthcare system,” she added.

However, many young adults, even those who are employed, are skipping health insurance altogether, which removes opportunities for preventive care, said Clark. Acquiring health insurance is expensive and time-consuming, and she doesn’t blame young adults who give it a pass, but she noted that they may be putting themselves at risk for problems later in life.

“The concern is that it might put them in a ‘problem-focused’ mindset when it comes to their health; they wait until there’s a problem and then choose between an urgent care center or emergency department, depending on how bad it is,” she said. “What’s missing is attention to preventive care,” she added.

The new report from the University of Michigan’s C.S. Mott Children’s Hospital calls into question whether young adults are equipped for routine healthcare engagement, said Callahan. “The tasks measured seem fundamental, but 1 in 6 parents reported that their young adult child performed zero of these six basic benchmarks independently,” he said.

“Fortunately, nearly 60% of parents reported that their young adult child handled most of these tasks on their own, defined as at least four out of six benchmarks,” Callahan said. However, the findings raise a critical question not only for primary care providers, but for those engaged in health policy, he said. Namely, what factors enabled that top 60% to build healthcare self-efficacy, and what went missing for the bottom 16% that left them entirely dependent on their parents?

When parents in the poll were asked about their primary concerns for their young adult children, they pointed to lifestyle habits such excessive screen time, elevated stress levels, poor sleep, and poor diet over chronic physical and mental conditions. “These daily lifestyle factors are precisely what primary care is designed to address before they manifest as chronic disease,” Callahan said.

“In an era where healthcare systems are increasingly prioritizing preventive care to curb ballooning costs, getting patients through the door early in life matters,” Callahan added. “Some may argue that parents simply need to step back and allow their adult children to step up,” he said. However, especially for young adults operating without parental guidance, difficulty promotes disengagement, he added.

Parents and caregivers have opportunities to teach their teens and young adult children to take responsibility for their own health and healthcare, like setting up their own appointments, Clark and colleagues wrote in their report on the survey results. For children with mental health conditions, educating them about the names of their medications, how to obtain their prescriptions, and the needed frequency of visits should start early, they added.

The survey doesn’t provide a simple solution but highlights the need for more attention to engaging young adults in healthcare, Callahan agreed. “For a generation accustomed to managing every aspect of their lives seamlessly on the internet, the historic workflow of gaining access to healthcare acts as a significant barrier,” said Callahan. “Picking up the phone and spending untold time on hold is enough to dissuade many,” he added.

“Health systems must rethink how we meet young adults,” said Callahan. “Identifying a doctor and booking a preventive visit must become as easy as booking a flight or ordering dinner. By lowering the bar to access, healthcare networks can empower the next generation to take ownership of their health,” he said.

The survey was supported by the C.S. Mott Children’s Hospital, the Department of Pediatrics at University of Michigan, and the Susan B. Meister Child Health Evaluation and Research Center.