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Outreach strategies for expanding health insurance coverage in children
Qingyue Meng1, Beibei Yuan, Liying Jia
1Center for Health Management and Policy, Shandong University, Wenhua Xi Road 44, Jinan, Shandong, China, 250012.
Insights
Outreach strategies like case management and providing application materials in emergency departments can improve children's health insurance coverage. Further research is needed to evaluate diverse strategies globally.
Area of Science:
- Health Services Research
- Public Health Policy
- Health Insurance Access
Background:
- Health insurance is crucial for healthcare access and financial protection.
- Low insurance coverage persists, especially among vulnerable populations.
- Targeted interventions are needed to increase enrollment in eligible health insurance schemes.
Purpose of the Study:
- To evaluate the effectiveness of outreach strategies in increasing health insurance coverage for eligible children.
- To synthesize evidence from rigorous study designs on outreach interventions.
Main Methods:
- Systematic review of randomized controlled trials, controlled clinical trials, controlled before-after studies, and interrupted time series.
- Searched multiple databases including Cochrane EPOC, PubMed, EMBASE, and PsycINFO.
- Data extraction and risk of bias assessment by two independent reviewers; narrative synthesis of findings.
Main Results:
- Two studies from the US were included.
- Community-based case managers effectively enrolled and maintained Latino American children in health insurance schemes.
- Distributing application materials in hospital emergency departments increased children's insurance enrollment.
Conclusions:
- Outreach strategies, including information provision, application assistance, and material distribution, can enhance children's health insurance coverage in the US.
- Further research is recommended to assess various outreach strategies in different global contexts, emphasizing robust study designs.
Background:
Health insurance has the potential to improve access to health care and protect people from healthcare costs when they are ill. However, coverage is often low, particularly in people most in need of protection.
Objectives:
To assess the effectiveness of outreach strategies for expanding insurance coverage of children who are eligible for health insurance schemes.
Search Strategy:
We searched the Cochrane Effective Practice and Organisation of Care Group (EPOC) Specialised Register (The Cochrane Library 2009, Issue 2), PubMed (January 1951 to January 2010), EMBASE (January 1966 to April 2009), PsycINFO (January 1967 to April 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.
Selection Criteria:
Randomised 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. We defined outreach strategies as measures to improve the implementation of existing health insurance to enrol more eligible populations. This included increasing awareness of schemes, modifying enrolment, improving management and organis ation of insurance schemes, and mixed strategies.
Data Collection And Analysis:
Two review authors independently extracted data and assessed the risk of bias . We narratively summari sed the data.
Main Results:
We included two studies, both from the United States. One randomised controlled trial study with a low risk of bias showed that community- based case managers who provided health insurance information, application support, and negotiated with the insurer were effective in enrolling and maintaining enrolment of Latino American children into health insurance schemes (n = 257). The second quasi-randomised controlled trial, with an unclear risk of bias (n = 223), indicated that handing out insurance application materials in hospital emergenc y departments can increase enrolment of children into health insurance.
Authors' Conclusions:
The two studies included in this review provide evidence that in the US providing health insurance information and application assistance, and handing out application materials in hospital emergency departments can probably both improve insurance coverage of children. 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.
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