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A randomized, controlled trial of the effectiveness of community-based case management in insuring uninsured Latino
Glenn Flores1, Milagros Abreu, Christine E Chaisson
1Center for the Advancement of Underserved Children, Medical College of Wisconsin, Milwaukee, WI 53226, USA. gflores@mail.mcw.edu
Insights
Case managers significantly improved health insurance enrollment for uninsured Latino children compared to traditional outreach. This approach offers a promising strategy to reduce child uninsurance in vulnerable populations.
Area of Science:
- Public Health
- Health Services Research
- Child Health Policy
Background:
- Lack of health insurance negatively impacts children's health, with Latino children facing the highest risk of being uninsured in the US.
- Eight million children in the US lack health insurance, highlighting a critical public health concern.
- No prior randomized controlled trials have compared different public insurance strategies for uninsured children.
Purpose of the Study:
- To determine if case managers are more effective than traditional methods in securing health insurance for uninsured Latino children.
- To evaluate the impact of a case management intervention on insurance acquisition and continuity for a high-risk pediatric population.
Main Methods:
- A randomized controlled trial was conducted from May 2002 to August 2004, involving 275 uninsured Latino children and their parents in Boston.
- Participants were randomly assigned to either an intervention group receiving support from trained case managers or a control group receiving standard Medicaid and State Children's Health Insurance Program (SCHIP) outreach.
- Case managers assisted families with eligibility information, application completion, liaison services, and maintaining coverage, with outcomes assessed over one year by blinded researchers.
Main Results:
- Children in the intervention group were significantly more likely to obtain health insurance (96% vs. 57%) with adjusted odds 7.78 times higher than the control group.
- Continuous insurance coverage was achieved by 78% of intervention group children compared to 30% in the control group.
- Intervention group children secured insurance faster (mean 87.5 days vs. 134.8 days), and their parents reported higher satisfaction.
Conclusions:
- Community-based case management is a superior strategy to traditional outreach for insuring uninsured Latino children.
- Case management presents a viable and effective mechanism for reducing the number of uninsured children, particularly within high-risk demographic groups.
- The findings support the integration of case management services into public health insurance programs to improve access and equity.
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.
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