Outreach Strategies for Expanding Health Insurance Coverage in Children_Chinese Journal of Evidence-Based Medicine

Authors：

YUAN Beibei , JIA Liying ¹ , WANG Jian ¹ ,  MENG Qingyue ¹ , Paul Garner ¹

1. Centre for Health Management and Policy, Shandong University; Key Lab for Health Economics and Policy Research of Ministry of Health, Jinan 250012, China;2. Liverpool School of Tropical Medicine, Liverpool, UK;

Corresponding author：

MENG Qingyue, Email: qmeng@sdu.edu.cn

Keywords：

Children; Health insurance; Coverage; Systematic review

DOI：

10.7507/1672-2531.20100558

Video：

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Objective 　To assess the effectiveness of outreach strategies for expanding insurance coverage of children who are eligible for health insurance schemes.
Methods 　We searched The Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 2), PubMed (1951 to 2010), EMBASE (1966 to 2009), PsycINFO (1967 to 2009) and other relevant databases and websites. In addition, we searched the reference lists of included studies and relevant reviews, and carried out a citation search for included studies to find more potentially relevant studies. Randomized controlled trials, controlled clinical trials, controlled before-after studies and interrupted time series which evaluated the effects of outreach strategies on increasing health insurance coverage for children. The included strategies were increasing awareness of schemes, modifying enrolment, improving management and organization of insurance schemes, and mixed strategies. Two review authors independently screened literatures, extracted data and assessed the risk of bias. We narratively summarized the data.
Results 　We included two studies, both from the United States. One randomized controlled trial study with a low risk of bias showed that community-based case managers who provided health insurance information, application support were effective in enrolling Latino American children into health insurance schemes (RR=1.68, 95%CI 1.44 to 1.96, n=257). The second quasi-randomized controlled trial, with an unclear risk of bias, indicated that handing out insurance application materials in hospital emergency departments can increase enrolment of children into health insurance (RR=1.50, 95% CI 1.03 to 2.18, n=223).
Conclusion 　The two studies included in this review provide evidence that providing health insurance information and application assistance and handing out application materials in hospital emergency departments can probably both improve insurance coverage of children. But the application of the interventions to other countries beyond the US still depends on contextual factors of health medical systems. Further studies evaluating the effectiveness of different outreach strategies for expanding health insurance coverage of children in different countries are needed, with careful attention given to study design.

Citation： YUAN Beibei,JIA Liying,WANG Jian,MENG Qingyue,Paul Garner. Outreach Strategies for Expanding Health Insurance Coverage in Children. Chinese Journal of Evidence-Based Medicine, 2010, 10(10): 1131-1137. doi: 10.7507/1672-2531.20100558 Copy

1.	Kuehl KS, Baffa JM, Chase GA. Insurance and education determine survival in infantile coarctation of the aorta. Journal of Health Care for the Poor and Underserved, 2000, 11: 400-411.
2.	Zhang X, Wang L, Zhu X, et al. Knowledge, attitude and practice survey on immunization service delivery in Guangxi and Gansu, China. Social Science & Medicine, 1999, 49: 1125-1127.
3.	Hisao W. Design and implementation of Social Health Insurance. World Bank Institute: WBI Development Studies, 2007.
4.	Carrin G, James C. Social Health insurance: key factors affecting the transition towards universal coverage. Internal Social Security Review, 2005, 58(1): 45-64.
5.	DeNavas-Walt C, Proctor BD, Lee CH. Income, poverty, and health insurance coverage in the United States: 2005. Washington, DC: US Government Printing Office, 2005.
6.	Lu M, Zhang J, Ma J, et al. Child health insurance coverage: a survey among temporary and permanent residents in Shanghai. BMC Health Services Research, 2008, 8: 238.
7.	袁蓓蓓, 贾莉英, 王健, 等. 扩大脆弱人群健康保险覆盖率的策略: 描述性系统评价. 中国循证医学杂志, 2008, 8(9): 744-756.
8.	Jacobson M, Buchmueller TC. Can private companies contribute to public programs’outreach efforts? Evidence from California. Health Affairs, 2007, 26(2): 538-548.
9.	Langwell K, Laschober M, Cox D, et al. American Indian and Alaska Native eligibility and enrollment in Medicaid, SCHIP and Medicare. Centers for Medicare & Medicaid Services, 2003 December.
10.	Haley J, Kenney G. Low-income uninsured children with special health care needs: why aren’t they enrolled in public health insurance programs? Pediatrics, 2007, 119: 60-68.
11.	Andrulis DP, Bauer TA, Hopkins S. Strategies to increase enrollment in children’s health insurance programs: A guide to outreach, marketing and enrollment in New York and other states. A report of the New York Academy of Medicine. Journal of Urban Health, 1999, 76: 247-279.
12.	Buchmueller TC, Jacobson M. Can private companies contribute to public outreach efforts? Evidence from California. Health Affairs, 2007, 26: 538-548.
13.	Carrin G. Community Based Health Insurance Schemes in developing countries: facts, problems and perspectives. World Health Organization, 2003.
14.	Zambrana RE, Carter-Pokras O. Improving health insurance coverage for Latino children: a review of barriers, challenges and State strategies. Journal of the National Medical Association, 2004, 96: 508-523.
15.	The GRADE working group. Grading quality of evidence and strength of recommendations. BMJ, 2004, 328: 1490-1494.
16.	Flores G, Abreu M, Chaisson CE, et al. A randomized, controlled trial of the effectiveness of community-based case management in insuring uninsured Latino children. Pediatrics, 2005, 116: 1433-1441.
17.	Gordon JA, Emond JA, Camargo CA. The State Children’s Health Insurance Program: a multicenter trial of outreach through the emergency department. American Journal of Public Health, 2005, 95(2): 250-253.
18.	Aizer A. Covering Kids: efforts to increase the health insurance coverage of poor children. University of California, Los Angeles, 2002.
19.	Aizer A. Public health insurance, program take-up, and child health. Working paper, National Bureau of Economic Research, 2006.
20.	Bansak C, Raphael S. The effects of state policy design features on take-up and crowd-out rates for the State Children’s Health Insurance Program. Journal of Policy Analysis and Management, 2006, 26(1): 149-175.
21.	Brown AM, Glazer G. Enrollment success in state children’s health insurance program after free clinic referral. Journal of Pediatric Health Care, 2004, 18(3): 145-148.
22.	Carter TM. Alabama rural partnerships: addressing the health needs of school children. United States, Alabama, The University of Alabama, 2006.
23.	Chen JY, Swonger S, Kominski G, et al. Cost-effectiveness of insuring the uninsured: the case of Korean American children. Medical Decision Making, 2009, 29: 51-60.
24.	Cousineau MR, Wada EO, Hogan L. Enrolling in Medicaid through the National School Lunch Program: outcome of a pilot project in California schools. Public Health Reports, 2007, 122(4): 452-460.
25.	Dutton M, Katz S, Pennington A. Using community groups and student volunteers to enroll uninsured children in Medicaid and children health plus. The Commonwealth Fund, 2000.
26.	Gordon JA, Dupuie TA. Child health insurance outreach through the emergency department: a pilot study. Academic Emergency Medicine, 2001, 8(11): 1088-1090.
27.	Hill I, Dubay L, Kenney GM, et al. Improving coverage and access for immigrant Latino children: the Los Angeles healthy kids program. Health Affair, 2008, 27(2): 550-559.
28.	Kincheloe JR. The determinants of participation in California’s Medi-Cal and Healthy Families Programs by eligible children. United States, California, University of California, Los Angeles, 2004.
29.	Lee HJ, Tian WH. The State Children’s Health Insurance Program: participation and substitution. The Social Science Journal, 2008, 45(3): 382-400.
30.	Lichtenstein B, Sharma AK, Wheat JR. Health inequity: the plight of uninsured children in a rural Alabama county and the plan to cure it. Family and Community Health, 2005, 28(2): 156-167.
31.	Mahajan P, Stanley R, Ross KW, et al. Evaluation of an emergency department-based enrollment program for uninsured children. Annals of Emergency Medicine, 2005, 45(3): 245-250.
32.	Meyer CL, Brun C, Yung B, et al. Evaluation of social marketing efforts designed to increase enrollment in the Children’s Health Insurance Program (CHIP). Journal of Nonprofit & Public Sector Marketing, 2004, 12(2): 87-104.
33.	Ray J, White M, Cannon P, et al. Implementing the Florida KidCare open enrollment communications campaign: a framework for mobilizing community partners to reduce the number of uninsured children. International Quarterly of Community Health Education, 2006, 26(4): 365-377.
34.	Sieben I, Rosenberg TJ, Bazile Y. The Role of WIC Center and Small Businesses in Enrolling Uninsured Children in Medicaid and Child Health Plus. Medical and Health Research Association of New York City, Inc. 2000.
35.	Wada EO, Cousineau MR. Assessing community-based outreach and enrollment activities and outcomes relative to need in Los Angeles County. The Center for Community Health Studies, USC Keck School of Medicine, Department of Family Medicine, 2006.
36.	Wolfe B, Scrivner S. The devil may be in the details: how the characteristics of SCHIP programs affect take-up. Journal of Policy Analysis and Management, 2005, 24(3): 499-522.
37.	Ziegenfuss JK. Encouraging eligible children’s participation in public health insurance: the role of national awareness campaigns. United States, Minnesota, University of Minnesota, 2008.
38.	Carpenter BM, Kavanagh L. Outreach to children: moving from enrollment to ensuring access. Bright Futures in Managed Care Project at the National Institute for Health Care Management, the Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services, 1998.

1. Kuehl KS, Baffa JM, Chase GA. Insurance and education determine survival in infantile coarctation of the aorta. Journal of Health Care for the Poor and Underserved, 2000, 11: 400-411.
2. Zhang X, Wang L, Zhu X, et al. Knowledge, attitude and practice survey on immunization service delivery in Guangxi and Gansu, China. Social Science & Medicine, 1999, 49: 1125-1127.
3. Hisao W. Design and implementation of Social Health Insurance. World Bank Institute: WBI Development Studies, 2007.
4. Carrin G, James C. Social Health insurance: key factors affecting the transition towards universal coverage. Internal Social Security Review, 2005, 58(1): 45-64.
5. DeNavas-Walt C, Proctor BD, Lee CH. Income, poverty, and health insurance coverage in the United States: 2005. Washington, DC: US Government Printing Office, 2005.
6. Lu M, Zhang J, Ma J, et al. Child health insurance coverage: a survey among temporary and permanent residents in Shanghai. BMC Health Services Research, 2008, 8: 238.
7. 袁蓓蓓, 贾莉英, 王健, 等. 扩大脆弱人群健康保险覆盖率的策略: 描述性系统评价. 中国循证医学杂志, 2008, 8(9): 744-756.
8. Jacobson M, Buchmueller TC. Can private companies contribute to public programs’outreach efforts? Evidence from California. Health Affairs, 2007, 26(2): 538-548.
9. Langwell K, Laschober M, Cox D, et al. American Indian and Alaska Native eligibility and enrollment in Medicaid, SCHIP and Medicare. Centers for Medicare & Medicaid Services, 2003 December.
10. Haley J, Kenney G. Low-income uninsured children with special health care needs: why aren’t they enrolled in public health insurance programs? Pediatrics, 2007, 119: 60-68.
11. Andrulis DP, Bauer TA, Hopkins S. Strategies to increase enrollment in children’s health insurance programs: A guide to outreach, marketing and enrollment in New York and other states. A report of the New York Academy of Medicine. Journal of Urban Health, 1999, 76: 247-279.
12. Buchmueller TC, Jacobson M. Can private companies contribute to public outreach efforts? Evidence from California. Health Affairs, 2007, 26: 538-548.
13. Carrin G. Community Based Health Insurance Schemes in developing countries: facts, problems and perspectives. World Health Organization, 2003.
14. Zambrana RE, Carter-Pokras O. Improving health insurance coverage for Latino children: a review of barriers, challenges and State strategies. Journal of the National Medical Association, 2004, 96: 508-523.
15. The GRADE working group. Grading quality of evidence and strength of recommendations. BMJ, 2004, 328: 1490-1494.
16. Flores G, Abreu M, Chaisson CE, et al. A randomized, controlled trial of the effectiveness of community-based case management in insuring uninsured Latino children. Pediatrics, 2005, 116: 1433-1441.
17. Gordon JA, Emond JA, Camargo CA. The State Children’s Health Insurance Program: a multicenter trial of outreach through the emergency department. American Journal of Public Health, 2005, 95(2): 250-253.
18. Aizer A. Covering Kids: efforts to increase the health insurance coverage of poor children. University of California, Los Angeles, 2002.
19. Aizer A. Public health insurance, program take-up, and child health. Working paper, National Bureau of Economic Research, 2006.
20. Bansak C, Raphael S. The effects of state policy design features on take-up and crowd-out rates for the State Children’s Health Insurance Program. Journal of Policy Analysis and Management, 2006, 26(1): 149-175.
21. Brown AM, Glazer G. Enrollment success in state children’s health insurance program after free clinic referral. Journal of Pediatric Health Care, 2004, 18(3): 145-148.
22. Carter TM. Alabama rural partnerships: addressing the health needs of school children. United States, Alabama, The University of Alabama, 2006.
23. Chen JY, Swonger S, Kominski G, et al. Cost-effectiveness of insuring the uninsured: the case of Korean American children. Medical Decision Making, 2009, 29: 51-60.
24. Cousineau MR, Wada EO, Hogan L. Enrolling in Medicaid through the National School Lunch Program: outcome of a pilot project in California schools. Public Health Reports, 2007, 122(4): 452-460.
25. Dutton M, Katz S, Pennington A. Using community groups and student volunteers to enroll uninsured children in Medicaid and children health plus. The Commonwealth Fund, 2000.
26. Gordon JA, Dupuie TA. Child health insurance outreach through the emergency department: a pilot study. Academic Emergency Medicine, 2001, 8(11): 1088-1090.
27. Hill I, Dubay L, Kenney GM, et al. Improving coverage and access for immigrant Latino children: the Los Angeles healthy kids program. Health Affair, 2008, 27(2): 550-559.
28. Kincheloe JR. The determinants of participation in California’s Medi-Cal and Healthy Families Programs by eligible children. United States, California, University of California, Los Angeles, 2004.
29. Lee HJ, Tian WH. The State Children’s Health Insurance Program: participation and substitution. The Social Science Journal, 2008, 45(3): 382-400.
30. Lichtenstein B, Sharma AK, Wheat JR. Health inequity: the plight of uninsured children in a rural Alabama county and the plan to cure it. Family and Community Health, 2005, 28(2): 156-167.
31. Mahajan P, Stanley R, Ross KW, et al. Evaluation of an emergency department-based enrollment program for uninsured children. Annals of Emergency Medicine, 2005, 45(3): 245-250.
32. Meyer CL, Brun C, Yung B, et al. Evaluation of social marketing efforts designed to increase enrollment in the Children’s Health Insurance Program (CHIP). Journal of Nonprofit & Public Sector Marketing, 2004, 12(2): 87-104.
33. Ray J, White M, Cannon P, et al. Implementing the Florida KidCare open enrollment communications campaign: a framework for mobilizing community partners to reduce the number of uninsured children. International Quarterly of Community Health Education, 2006, 26(4): 365-377.
34. Sieben I, Rosenberg TJ, Bazile Y. The Role of WIC Center and Small Businesses in Enrolling Uninsured Children in Medicaid and Child Health Plus. Medical and Health Research Association of New York City, Inc. 2000.
35. Wada EO, Cousineau MR. Assessing community-based outreach and enrollment activities and outcomes relative to need in Los Angeles County. The Center for Community Health Studies, USC Keck School of Medicine, Department of Family Medicine, 2006.
36. Wolfe B, Scrivner S. The devil may be in the details: how the characteristics of SCHIP programs affect take-up. Journal of Policy Analysis and Management, 2005, 24(3): 499-522.
37. Ziegenfuss JK. Encouraging eligible children’s participation in public health insurance: the role of national awareness campaigns. United States, Minnesota, University of Minnesota, 2008.
38. Carpenter BM, Kavanagh L. Outreach to children: moving from enrollment to ensuring access. Bright Futures in Managed Care Project at the National Institute for Health Care Management, the Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services, 1998.

Chinese Journal of Evidence-Based Medicine

Outreach Strategies for Expanding Health Insurance Coverage in Children

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