Address correspondence to Michael R. Cousineau, Dr.P.H., Associate Professor, Department of Family Medicine and Preventive Medicine, University of Southern California, Keck School of Medicine, 1000 Fremont Ave., Unit 80, Alhambra, CA 91803; e-mail: firstname.lastname@example.org. Gregory D. Stevens, Ph.D., Assistant Professor, is with the Department of Family Medicine, University of Southern California, Keck School of Medicine, Alhambra, CA. Albert Farias, M.P.H., is with the Department of Family Medicine, University of Southern California, Alhambra, CA.
Measuring the Impact of Outreach and Enrollment Strategies for Public Health Insurance in California
Article first published online: 5 NOV 2010
© Health Research and Educational Trust
Health Services Research
Volume 46, Issue 1p2, pages 319–335, February 2011
How to Cite
Cousineau, M. R., Stevens, G. D. and Farias, A. (2011), Measuring the Impact of Outreach and Enrollment Strategies for Public Health Insurance in California. Health Services Research, 46: 319–335. doi: 10.1111/j.1475-6773.2010.01202.x
- Issue published online: 3 JAN 2011
- Article first published online: 5 NOV 2010
- health insurance;
- health care reform;
- Healthy Kids;
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.
Data Source. Administrative enrollment databases.
Study Design. 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.
Data Collection. 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.
Principal Findings. 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.
Conclusions and Implications. 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.