BACKGROUND: Lack of health insurance adversely affects children's health. Eight million US children are uninsured, with Latinos being the racial/ethnic group at greatest risk for being uninsured. A randomized, controlled trial comparing the effectiveness of various public insurance strategies for insuring uninsured children has never been conducted. OBJECTIVE: To evaluate whether case managers are more effective than traditional methods in insuring uninsured Latino children. DESIGN: Randomized, controlled trial conducted from May 2002 to August 2004. SETTING AND PARTICIPANTS: A total of 275 uninsured Latino children and their parents were recruited from urban community sites in Boston. INTERVENTION: Uninsured children were assigned randomly to an intervention group with trained case managers or a control group that received traditional Medicaid and State Children's Health Insurance Program (SCHIP) outreach and enrollment. Case managers provided information on program eligibility, helped families complete insurance applications, acted as a family liaison with Medicaid/SCHIP, and assisted in maintaining coverage. MAIN OUTCOME MEASURES: Obtaining health insurance, coverage continuity, the time to obtain coverage, and parental satisfaction with the process of obtaining insurance for children were assessed. Subjects were contacted monthly for 1 year to monitor outcomes by a researcher blinded with respect to group assignment. RESULTS:One hundred thirty-nine subjects were assigned randomly to the intervention group and 136 to the control group. Intervention group children were significantly more likely to obtain health insurance (96% vs 57%) and had approximately 8 times the adjusted odds (odds ratio: 7.78; 95% confidence interval: 5.20-11.64) of obtaining insurance. Seventy-eight percent of intervention group children were insured continuously, compared with 30% of control group children. Intervention group children obtained insurance significantly faster (mean: 87.5 vs 134.8 days), and their parents were significantly more satisfied with the process of obtaining insurance. CONCLUSIONS: Community-based case managers are more effective than traditional Medicaid/SCHIP outreach and enrollment in insuring uninsured Latino children. Case management may be a useful mechanism to reduce the number of uninsured children, especially among high-risk populations.
RCT Entities:
BACKGROUND: Lack of health insurance adversely affects children's health. Eight million US children are uninsured, with Latinos being the racial/ethnic group at greatest risk for being uninsured. A randomized, controlled trial comparing the effectiveness of various public insurance strategies for insuring uninsured children has never been conducted. OBJECTIVE: To evaluate whether case managers are more effective than traditional methods in insuring uninsured Latino children. DESIGN: Randomized, controlled trial conducted from May 2002 to August 2004. SETTING AND PARTICIPANTS: A total of 275 uninsured Latino children and their parents were recruited from urban community sites in Boston. INTERVENTION: Uninsured children were assigned randomly to an intervention group with trained case managers or a control group that received traditional Medicaid and State Children's Health Insurance Program (SCHIP) outreach and enrollment. Case managers provided information on program eligibility, helped families complete insurance applications, acted as a family liaison with Medicaid/SCHIP, and assisted in maintaining coverage. MAIN OUTCOME MEASURES: Obtaining health insurance, coverage continuity, the time to obtain coverage, and parental satisfaction with the process of obtaining insurance for children were assessed. Subjects were contacted monthly for 1 year to monitor outcomes by a researcher blinded with respect to group assignment. RESULTS: One hundred thirty-nine subjects were assigned randomly to the intervention group and 136 to the control group. Intervention group children were significantly more likely to obtain health insurance (96% vs 57%) and had approximately 8 times the adjusted odds (odds ratio: 7.78; 95% confidence interval: 5.20-11.64) of obtaining insurance. Seventy-eight percent of intervention group children were insured continuously, compared with 30% of control group children. Intervention group children obtained insurance significantly faster (mean: 87.5 vs 134.8 days), and their parents were significantly more satisfied with the process of obtaining insurance. CONCLUSIONS: Community-based case managers are more effective than traditional Medicaid/SCHIP outreach and enrollment in insuring uninsured Latino children. Case management may be a useful mechanism to reduce the number of uninsured children, especially among high-risk populations.
Authors: Jacqueline Martinez; Marguerite Ro; Normandy William Villa; Wayne Powell; James R Knickman Journal: Am J Public Health Date: 2011-10-20 Impact factor: 9.308
Authors: Simon Lewin; Susan Munabi-Babigumira; Claire Glenton; Karen Daniels; Xavier Bosch-Capblanch; Brian E van Wyk; Jan Odgaard-Jensen; Marit Johansen; Godwin N Aja; Merrick Zwarenstein; Inger B Scheel Journal: Cochrane Database Syst Rev Date: 2010-03-17
Authors: Glorisa Canino; Elizabeth L McQuaid; Maria Alvarez; Angel Colon; Cynthia Esteban; Vivian Febo; Robert B Klein; Daphne Koinis Mitchell; Sheryl J Kopel; Federico Montealegre; Alexander N Ortega; Jose Rodriguez-Santana; Ronald Seifer; Gregory K Fritz Journal: Pediatr Pulmonol Date: 2009-09