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Child health insurance outreach through the emergency department: a pilot study
1Department of Emergency Medicine, Massachusetts General Hospital, Institute for Health Policy, Partners HealthCare System, Division of Emergency Medicine, Harvard Medical School, Boston, MA 02114-2696, USA. jgordon3@partners.org
Insights
Emergency departments (EDs) can effectively enroll uninsured children in health insurance programs. This pilot study shows ED outreach successfully connected families with government-sponsored coverage, highlighting EDs as key sites for future national initiatives.
Area of Science:
- Public Health
- Health Services Research
- Pediatrics
Background:
- The Children's Health Insurance Program (CHIP) has faced challenges in enrolling uninsured children.
- Children without insurance often utilize emergency departments (EDs) for care.
- No national initiatives have specifically targeted EDs for child health insurance outreach.
Purpose of the Study:
- To evaluate the effectiveness of child health insurance outreach within an emergency department (ED) setting.
- To serve as a pilot for a larger, national multicenter study on ED-based insurance enrollment.
- To assess the potential of EDs as a venue for improving children's health insurance access.
Main Methods:
- A prospective observational study was conducted at a single hospital ED over 12 months.
- A case manager approached parents of uninsured children (<18 years) presenting during duty hours.
- Information and applications for government-sponsored insurance were provided, with follow-up to confirm enrollment and link it to the ED intervention.
Main Results:
- Out of 78 participating children, 44% of families successfully obtained government-sponsored health insurance.
- Directly attributable enrollment to the ED intervention was confirmed for 31% of families.
- Of those gaining government insurance, the majority were enrolled in Medicaid.
Conclusions:
- Emergency departments represent a viable and important site for child health insurance outreach.
- National strategies to increase health insurance coverage for children should consider partnerships with EDs.
- ED-based outreach can effectively connect vulnerable children with essential health insurance benefits.
Unlabelled:
In 1997 the U.S. government funded the Children's Health Insurance Program (CHIP), but the 48 billion dollars initiative has had limited success in finding and enrolling uninsured children. While such children are more likely to receive care in emergency departments (EDs), no national initiative has targeted EDs for child health insurance outreach.
Objective:
As a pilot study for a national multicenter study, this study evaluated the effectiveness of child health insurance outreach in an ED setting.
Methods:
This was a prospective observational study of the outreach efforts of a single case manager from August 1998 to July 1999, performed at Foote Hospital ED in Jackson, Michigan (45,000 visits/year). All patients
Results:
Seventy-eight children participated (median age 7 years; 55% male; 87% white). Forty-four percent (95% CI = 32% to 55%) of families referred for government-sponsored child health insurance successfully obtained it; 31% (95% CI = 21% to 42%) could be traced directly to intervention efforts by interview (n = 17) or by state records (n = 7). Nineteen percent (95% CI = 11% to 30%) got other private insurance. Of those who got government-sponsored insurance due to the intervention, all but one were covered by Medicaid.
Conclusions:
The ED may be an important outreach site for child health insurance programs. National efforts to address the lack of insurance among children should include partnerships with the ED.