Measuring the impact of outreach and enrollment strategies for public health insurance in California.
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.


METHODS
Administrative enrollment databases.


METHODS
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
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.


RESULTS
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
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.
Department of Family Medicine and Preventive Medicine, University of Southern California, Keck School of Medicine, Alhambra, CA 91803, USA. cousinea@usc.edu
Michael R
MR
Cousineau
Gregory D
GD
Stevens
Albert
A
Farias
D002140:California; D002648:Child; D002662:Child Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D018166:Health Care Reform / Q000458:organization & administration / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D007348:Insurance, Health / Q000458:organization & administration* / Q000706:statistics & numerical data; D008389:Marketing of Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D008484:Medicaid / Q000458:organization & administration* / Q000706:statistics & numerical data; D013221:State Health Plans / Q000458:organization & administration* / Q000706:statistics & numerical data; D014481:United States