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Updated: Sep 13, 2025

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A Text Message Outreach Intervention to Increase Health Insurance Enrollment for Self-Pay Patients.

Yan Lu1, Kevin J Craten1, Caitlin T Thompson1

  • 1Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, Fort Worth, TX.

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|July 29, 2025
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Summary

Behaviorally informed text messages increased health insurance enrollment for self-pay patients leaving the emergency department at a safety-net hospital. This outreach strategy can help more uninsured individuals gain coverage.

Keywords:
digital outreachinsurancesafety-netself-paytext message

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Area of Science:

  • Health Services Research
  • Health Informatics
  • Public Health Interventions

Background:

  • Self-pay patients often lack awareness of eligibility for government or hospital medical assistance programs.
  • Emergency Department (ED) visits present a critical opportunity to connect uninsured patients with coverage options.

Purpose of the Study:

  • To evaluate the impact of behaviorally informed text message outreach on insurance enrollment among self-pay patients discharged from a safety-net hospital's ED.
  • To assess the effectiveness of this intervention across different demographic groups, including race and ethnicity.

Main Methods:

  • A single-arm trial with historical comparison design was emulated.
  • The study included self-pay ED patients aged 18-64 discharged during specific outreach and historical comparison periods.
  • Entropy balancing weights were used to adjust for baseline characteristics, and risk ratios (RR) and risk differences (RD) were calculated.

Main Results:

  • The outreach group (748 patients) showed a significant increase in any health coverage enrollment (RR=1.4, RD=7.1%) compared to the historical group (6199 patients).
  • The intervention had a larger effect on overall enrollment than on enrollment in hospital-based medical assistance programs and Medicaid (RR=1.2, RD=2.7%).
  • The positive effect on Medicaid and hospital program enrollment was most pronounced in the Hispanic population.

Conclusions:

  • Behaviorally informed text message outreach is an effective strategy to boost health insurance enrollment among self-pay patients from EDs at safety-net hospitals.
  • This text-based approach can supplement existing efforts to expand health insurance coverage.
  • Further research is recommended to explore and compare various text messaging strategies for optimal impact.