Department of Family Medicine and Preventive Medicine, University of Southern California, Keck School of Medicine, Alhambra, CA 91803, USA.
Health Serv Res. 2011 Feb;46(1 Pt 2):319-35. doi: 10.1111/j.1475-6773.2010.01202.x. Epub 2010 Nov 5.
OBJECTIVE AND STUDY SETTING: To evaluate the effectiveness of different approaches to outreach on public health insurance enrollment in 25 California counties with a Children's Health Initiative.
Administrative enrollment databases.
The use of eight enrollment strategies were identified in each quarter from 2001 to 2007 for each of 25 counties (county quarter). Strategies were categorized as either technology or nontechnology. New enrollments were obtained for Medi-Cal, Healthy Families, and Healthy Kids. Bivariate and multivariate analyses assessed the link between each strategy and new enrollments rates of children.
Methods Surveys of key informants determined whether a specific outreach strategy was used in each quarter. These were linked to new enrollments in each county quarter.
Between 2001 and 2007, enrollment grew in all three children's health programs. We controlled for the effects of counties, seasons, and county-specific child poverty rates. There was an increase in enrollment rates of 11 percent in periods when technology-based systems were in use compared with when these approaches were inactive. Non-technology-based approaches, including school-linked approaches, yielded a 12 percent increase in new enrollments rates. Deploying seven to eight strategies yielded 54 percent more new enrollments per 10,000 children compared with periods with none of the specific strategies.
National health care reform provides new opportunities to expand coverage to millions of Americans. An investment in technology-based enrollment systems will maximize new enrollments, particularly into Medicaid; nontechnological approaches may help identify harder-to-reach populations. Moreover, incorporating several strategies, whether phased in or implemented simultaneously, will enhance enrollments.
目的和研究背景：评估在加利福尼亚 25 个有“儿童健康倡议”的县中开展外联活动以促进公共医疗保险参保的不同方法的效果。
数据来源：行政参保数据库。
研究设计：在 2001 年至 2007 年的每个季度中，在每个县（县季度）中确定了八种参保策略的使用情况。这些策略分为技术和非技术两类。获得了 Medi-Cal、Healthy Families 和 Healthy Kids 的新参保人数。采用双变量和多变量分析评估了每种策略与儿童新参保率之间的联系。
数据收集：方法对关键信息提供者进行调查，以确定在每个季度是否使用了特定的外联策略。这些策略与每个县季度的新参保人数相关联。
主要发现：在 2001 年至 2007 年期间，所有三种儿童健康计划的参保人数都有所增加。我们控制了县、季节和特定县的儿童贫困率的影响。与这些方法不活跃时相比，使用基于技术的系统时，参保人数增长率增加了 11%。包括与学校挂钩的方法在内的非技术方法使新参保人数增长率增加了 12%。与没有具体策略的时期相比，每 10000 名儿童部署 7 到 8 种策略可使新参保人数增加 54%。
结论和意义：国家医疗保健改革为向数百万美国人扩大保险范围提供了新的机会。对基于技术的参保系统的投资将最大限度地增加新参保人数，特别是在 Medicaid 中；非技术方法可能有助于确定更难接触到的人群。此外，无论分阶段实施还是同时实施，采用几种策略都将提高参保人数。
