Chen Judy Y, Swonger Sharon, Kominski Gerald, Liu Honghu, Lee Ji Eun, Diamant Allison
UCLA Department of Medicine and Health Services Research, University of California-Los Angeles, 911 Boxton Avenue, Los Angeles, CA 90024, USA.
Med Decis Making. 2009 Jan-Feb;29(1):51-60. doi: 10.1177/0272989X08322011. Epub 2009 Jan 6.
More than one-quarter of Korean American children are uninsured, and many are eligible for children's health insurance programs. The objective of this study is to evaluate the effectiveness and cost-effectiveness of different school-based health insurance strategies to provide coverage to uninsured Korean American children.
The authors used a quasi-experimental nonequivalent control group design, conducted from July to December 2005 in Los Angeles, California. The subjects were in 3 groups/schools (n = 1181). Parents received a variation of outreach methods (i.e., information sheets, school site presentations, automated telephone messages, personal telephone calls) and application assistance (i.e., telephone helpline, on-site assistance). The authors used bivariate and multivariable analysis to assess effectiveness. Cost-effectiveness was performed using a 3-stage model and Monte Carlo simulation.
Of the uninsured in the intensive intervention group, 41% applied for insurance compared with 13% of the control group (P = 0:002). This success was due to personal telephone calls. Of the uninsured in the intensive intervention group, 23% enrolled in insurance compared with 10% of the control group (P = 0:048). The most common reason reported by parents for nonenrollment despite assistance was failure to mail in the application. Despite the small increase in insurance enrollment from the intensive intervention strategy compared with the control group, it is cost-effective.
Personal telephone calls are effective in increasing outreach for children's health insurance application. However, more research is needed to investigate why parents fail to mail in the application. Ultimately, insuring more children will result in cost-effective improvements in quality-adjusted life years.
超过四分之一的韩裔美国儿童没有医疗保险，而且许多人符合儿童健康保险计划的资格。本研究的目的是评估不同的基于学校的医疗保险策略为未参保的韩裔美国儿童提供保险的有效性和成本效益。
作者采用了准实验非等效对照组设计，于2005年7月至12月在加利福尼亚州洛杉矶进行。研究对象分为3组/学校（n = 1181）。家长们收到了不同的宣传方式（即信息表、学校现场介绍、自动电话留言、个人电话）和申请协助（即电话帮助热线、现场协助）。作者使用双变量和多变量分析来评估有效性。成本效益分析采用三阶段模型和蒙特卡罗模拟。
在强化干预组的未参保者中，41%申请了保险，而对照组为13%（P = 0.002）。这一成功归因于个人电话。在强化干预组的未参保者中，23%登记参保，而对照组为10%（P = 0.048）。家长报告的尽管得到协助但未参保的最常见原因是未邮寄申请。尽管与对照组相比，强化干预策略使保险参保人数略有增加，但该策略具有成本效益。
个人电话在增加儿童健康保险申请的宣传方面是有效的。然而，需要更多研究来调查家长未邮寄申请的原因。最终，为更多儿童提供保险将在质量调整生命年方面带来具有成本效益的改善。
