1. The use of parent mentors resulted in a significant increase in the number of uninsured children obtaining insurance when compared to usual outreach.
2. Parent mentors are a cost-effective method of increasing insurance rates in children.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Eight percent of children in the United States remain uninsured, despite 60-70% of uninsured children being eligible for Medicaid or the Children’s Health Insurance Program (CHIP). The majority of uninsured children are African-American or Latino, creating significant racial/ethnic disparity in the availability of healthcare. Parent mentors are community health workers with at least one child enrolled in Medicaid and requiring medical treatment. These individuals also receive training to provide guidance and support to other parents with similar challenges. This study compared the use of parent mentors for insurance with usual outreach (e.g. radio and television advertising). Children in the parent mentor group were more likely to obtain health insurance, do so at a faster rate, and keep it for a longer period of time. They were also more likely to work with families who ultimately established with a primary care provider and who were less likely to have challenges obtaining specialty care or need extra income for medical expenses. In addition, parent mentors were more cost-effective than usual outreach. The study was performed in a single city with a high rate of uninsured children, which may limit its generalizability, particularly in less urban areas. However, it does suggest that the creation of insurance parent mentoring programs by hospitals, health systems, or insurance companies may generate more than enough revenue to offset the relatively low cost of the program.
In-Depth [randomized trial]: A total of 329 uninsured children from low-income, minority communities in Dallas, Texas were randomized to the control (n = 114) or parent mentor group (n = 123), with 92 being excluded from analysis due to no longer being eligible for Medicaid/CHIP, being lost to follow-up or withdrawing. Fifteen parent mentors were recruited and trained via a web-based system. They assisted parents by educating about insurance, helping with form completion, and liaising with insurance representatives. The control group received no mentorship or intervention beyond the usual advertising and outreach from Medicaid/CHIP. The demographic characteristics of both groups were similar (except gender, which was adjusted for), with both having a median age of 7 years, being approximately 65% Latino and 35% African-American, and with nearly 65% of each group lacking a primary care provider. After a year, primary analysis indicated that the PM group was significantly more likely than the control group to be insured (95% and 68%, respectively, p < 0.001; RR=1.30, 95%CI 1.21-1.32; adjusted OR: 2.93, 95%CI 2.14-4.00). Secondary analyses demonstrated reduced time to obtaining insurance for the PM group (median 62 vs. 140 days, p < 0.001) and improvements in having a primary care provider (40% vs. 16% declaring no primary care provider, p < 0.001). Costs for the parent mentor group were approximately $53 per month, but incremental cost effectiveness ratio showed a savings of $6045 per child insured per year.
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