Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #101797

Glenn Flores, MD, Center for the Advancement of Underserved Children, Medical College of Wisconsin/Children's Hospital of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, 414-456-8273, gflores@mail.mcw.edu, Milagros Abreu, MD, Boston University School of Public health, 715 Albany St., Talbot Building, Boston, MA 02118, Christine Chaisson, MPH, Data Coordinating Center, School of Public Health, Boston University, 715 Albany Street, 4T East, Boston, MA 02118, Alan F. Meyers, MD, MPH, Division of General Pediatrics, Boston Medical Center, 91 East Concord Street, Mat.Bldg., Rm 4205, Boston, MA 02118, and Ramesh Sachdeva, MD, PhD, MBA, Quantitative Health Sciences, Medical College of Wisconsin/Children's Hospital of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226.

Context: 8.4 million US children (11.4%) have no health insurance, and Latinos have the highest risk of being uninsured of any racial/ethnic group of children, with 21% of Latino children uninsured, vs. 7% of non-Latino whites, 14% of African-Americans, and 12% of Asians/Pacific Islanders. Lack of health insurance adversely affects children's health and healthcare. In the past 4 years, however, the number and proportion of uninsured children essentially has not changed, and over half of uninsured children (5 million) currently are eligible for Medicaid or SCHIP, suggesting more effective outreach and enrollment strategies are needed. Indeed, recent research indicates that SCHIP may be failing to reach the hardest-to-reach uninsured children, such as Latinos and those never insured. A randomized controlled trial has never been conducted comparing the effectiveness of various public insurance strategies for insuring uninsured children. 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/Participants: 275 uninsured Latino children and their parents were recruited from urban community sites in Boston. Intervention: Uninsured children were randomized to trained case managers or a control group receiving 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 interval to obtain coverage, and parental satisfaction with the process of obtaining insurance for children. Subjects were contacted monthly for 1 year to monitor outcomes by a researcher blinded to group assignment. Results: 139 subjects were randomized to the intervention and 136 to the control group. Intervention group children were more likely to obtain health insurance (96% vs. 57%, P<0.0001), and had almost 8 times the adjusted odds of obtaining insurance. 78% of intervention group children were continuously insured vs. 30% of controls (P<0.0001). Intervention group children obtained insurance faster (mean=87.5 days vs. 134.8 days; P<0.009), and their parents were more satisfied with the process of obtaining insurance (proportion very satisfied with process of obtaining insurance for child: 80% vs. 29%, P<0.0001). 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 further reduce the number of uninsured children, especially among high-risk populations.

Learning Objectives: At the conclusion of this presentation, the participant will be able to

• Identify the four outcomes in insuring uninsured children for which commmunity-based case managers outperform traditional Medicaid/SCHIP outreach and enrollment.
• Recognize how community-based case management is a potentially powerful tool for eliminating racial/ethnic disparities in health insurance coverage.

Keywords: Insurance, Latinos

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation