Easing the burden on health departments: a cost-effective method for public health nurses to increase private sector participation in the early and periodic screening, diagnosis, and treatment program.

Federal legislation requires states to increase use of the early and periodic screening, diagnosis, and treatment (EPSDT) program. The program provides comprehensive health services to children from low-income families on Medicaid and has been shown to improve health and reduce health care costs. Health departments and public health nurses (PHNs) bear a major burden conducting EPSDT screenings because many private physicians choose not to provide these services. Given scarce resources, health departments alone may be unable to meet the mandate for increased EPSDT services. Thus PHNs concerned about children's access to health care may have to encourage provision of EPSDT through the private sector. This project, phase I of the federally funded Healthy Kids Project to increase EPSDT use in rural areas of North Carolina, established the cost-effectiveness of a mailed intervention to recruit private physicians to do EPSDT screens that exceeded the capacity of health departments. The intervention, consisting of a personal letter, journal article, and pamphlet, was sent to all 73 primary care physicians in six rural counties. Before the mailing, 15 (21%) of the 73 physicians were willing to provide EPSDT screenings; after the mailing the number rose to 25 (34%). The one-time cost to recruit each provider was less than the estimated annual cost savings associated with each child in the EPSDT program.