A randomized, controlled trial of the effectiveness of community-based case management in insuring uninsured Latino children.
BACKGROUND
Lack of health insurance adversely affects children's health. Eight million US children are uninsured, with Latinos being the racial/ethnic group at greatest risk for being uninsured. A randomized, controlled trial comparing the effectiveness of various public insurance strategies for insuring uninsured children has never been conducted.


OBJECTIVE
To evaluate whether case managers are more effective than traditional methods in insuring uninsured Latino children.


METHODS
Randomized, controlled trial conducted from May 2002 to August 2004.


METHODS
A total of 275 uninsured Latino children and their parents were recruited from urban community sites in Boston.


METHODS
Uninsured children were assigned randomly to an intervention group with trained case managers or a control group that received 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.


METHODS
Obtaining health insurance, coverage continuity, the time to obtain coverage, and parental satisfaction with the process of obtaining insurance for children were assessed. Subjects were contacted monthly for 1 year to monitor outcomes by a researcher blinded with respect to group assignment.


RESULTS
One hundred thirty-nine subjects were assigned randomly to the intervention group and 136 to the control group. Intervention group children were significantly more likely to obtain health insurance (96% vs 57%) and had approximately 8 times the adjusted odds (odds ratio: 7.78; 95% confidence interval: 5.20-11.64) of obtaining insurance. Seventy-eight percent of intervention group children were insured continuously, compared with 30% of control group children. Intervention group children obtained insurance significantly faster (mean: 87.5 vs 134.8 days), and their parents were significantly more satisfied with the process of obtaining insurance.


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 reduce the number of uninsured children, especially among high-risk populations.
Flores
Glenn
G
Center for the Advancement of Underserved Children, Medical College of Wisconsin, Milwaukee, WI 53226, USA. gflores@mail.mcw.edu
Abreu
Milagros
M
Chaisson
Christine E
CE
Meyers
Alan
A
Sachdeva
Ramesh C
RC
Fernandez
Harriet
H
Francisco
Patricia
P
Diaz
Beatriz
B
Diaz
Ana Milena
AM
Santos-Guerrero
Iris
I
D001900:Boston; D019090:Case Management; D002648:Child; D002662:Child Health Services; D006630:Hispanic or Latino; D006801:Humans; D007348:Insurance, Health; D008484:Medicaid; D017057:Medically Uninsured / Q000208:ethnology