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Pediatrics. 2005 Dec;116(6):1433-41.

A randomized, controlled trial of the effectiveness of community-based case management in insuring uninsured Latino children.

Author information

1
Center for the Advancement of Underserved Children, Medical College of Wisconsin, Milwaukee, WI 53226, USA. gflores@mail.mcw.edu

Abstract

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.

PMID:
16322168
DOI:
10.1542/peds.2005-0786
[Indexed for MEDLINE]
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