Outreach strategies for expanding health insurance coverage in children.
BACKGROUND
Health insurance has the potential to improve access to health care and protect people from healthcare costs when they are ill. However, coverage is often low, particularly in people most in need of protection.


OBJECTIVE
To assess the effectiveness of outreach strategies for expanding insurance coverage of children who are eligible for health insurance schemes.


METHODS
We searched the Cochrane Effective Practice and Organisation of Care Group (EPOC) Specialised Register (The Cochrane Library 2009, Issue 2), PubMed (January 1951 to January 2010), EMBASE (January 1966 to April 2009), PsycINFO (January 1967 to April 2009) and other relevant databases and websites. In addition, we searched the reference lists of included studies and relevant reviews, and carried out a citation search for included studies to find more potentially relevant studies.


METHODS
Randomised controlled trials, controlled clinical trials, controlled before-after studies and interrupted time series which evaluated the effects of outreach strategies on increasing health insurance coverage for children. We defined outreach strategies as measures to improve the implementation of existing health insurance to enrol more eligible populations. This included increasing awareness of schemes, modifying enrolment, improving management and organis ation of insurance schemes, and mixed strategies.


METHODS
Two review authors independently extracted data and assessed the risk of bias . We narratively summari sed the data.


RESULTS
We included two studies, both from the United States. One randomised controlled trial study with a low risk of bias showed that community- based case managers who provided health insurance information, application support, and negotiated with the insurer were effective in enrolling and maintaining enrolment of Latino American children into health insurance schemes (n = 257). The second quasi-randomised controlled trial, with an unclear risk of bias (n = 223), indicated that handing out insurance application materials in hospital emergenc y departments can increase enrolment of children into health insurance.


CONCLUSIONS
The two studies included in this review provide evidence that in the US providing health insurance information and application assistance, and handing out application materials in hospital emergency departments can probably both improve insurance coverage of children. Further studies evaluating the effectiveness of different outreach strategies for expanding health insurance coverage of children in different countries are needed, with careful attention given to study design.
Meng
Qingyue
Q
Center for Health Management and Policy, Shandong University, Wenhua Xi Road 44, Jinan, Shandong, China, 250012.
Yuan
Beibei
B
Jia
Liying
L
Wang
Jian
J
Garner
Paul
P
D000293:Adolescent; D002648:Child; D004282:Documentation / Q000379:methods; D004636:Emergency Service, Hospital; D006801:Humans; D019458:Insurance Coverage / Q000458:organization & administration* / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000458:organization & administration* / Q000706:statistics & numerical data; D007843:Latin America / Q000208:ethnology; D017057:Medically Uninsured / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic; D014481:United States