Parent Mentors and Insuring Uninsured Children: A Randomized Controlled Trial.
Parent Mentors and Insuring Uninsured Children: A Randomized Controlled Trial.
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DOI：
10.1542/peds.2015-3519
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发表时间：
2016-04
期刊：
影响因子：
8
通讯作者：
Massey K
中科院分区：
文献类型：
--
作者：
Flores G;Lin H;Walker C;Lee M;Currie JM;Allgeyer R;Fierro M;Henry M;Portillo A;Massey K
600万美国儿童没有保险，尽管三分之二有资格获得医疗补助/儿童健康保险计划（CHIP），少数民族儿童的风险尤其高。然而，为没有保险的儿童提供保险的最有效方法尚不清楚。我们进行了一项随机试验的影响，父母导师（PM）投保未投保的少数民族儿童。PM是有经验的父母，他们有≥1名接受医疗补助/CHIP覆盖的儿童，接受2天的培训，然后通过保险申请、保留保险、医疗之家和社会需求帮助家庭1年;对照组接受传统的医疗补助/CHIP外展。主要结局是入组后1年获得保险。我们招募了237名参与者（114名对照; PM组123名）。PM比传统方法更有效（所有比较P<0.05），在为儿童提供保险（95% vs 68%），实现更快的覆盖（中位数= 62 vs 140天），高父母满意度（84% vs 62%）和覆盖更新（85% vs 60%）。PM儿童不太可能没有初级保健提供者（15%对39%），获得专科护理的问题（11%对46%），未满足的预防（4%对22%）或牙科（18%对31%）护理需求，对医生的不满（6%对16%），以及需要额外收入来支付医疗费用（6%对13%）。PM停止两年后，更多的PM儿童投保（100%对76%）。PM每月每个孩子的费用为53.05美元，但每年每个孩子的保险费为6045.22美元。PM比传统的医疗补助/CHIP方法更有效地为未投保的少数民族儿童提供保险，改善医疗保健服务，并实现父母的满意度，但价格低廉，成本效益高。
Six million US children are uninsured, despite two-thirds being eligible for Medicaid/Children’s Health Insurance Program (CHIP), and minority children are at especially high risk. The most effective way to insure uninsured children, however, is unclear. We conducted a randomized trial of the effects of parent mentors (PMs) on insuring uninsured minority children. PMs were experienced parents with ≥1 Medicaid/ CHIP-covered child who received 2 days of training, then assisted families for 1 year with insurance applications, retaining coverage, medical homes, and social needs; controls received traditional Medicaid/CHIP outreach. The primary outcome was obtaining insurance 1 year post-enrollment. We enrolled 237 participants (114 controls; 123 in PM group). PMs were more effective (P< .05 for all comparisons) than traditional methods in insuring children (95% vs 68%), and achieving faster coverage (median = 62 vs 140 days), high parental satisfaction (84% vs 62%), and coverage renewal (85% vs 60%). PM children were less likely to have no primary care provider (15% vs 39%), problems getting specialty care (11% vs 46%), unmet preventive (4% vs 22%) or dental (18% vs 31%) care needs, dissatisfaction with doctors (6% vs 16%), and needed additional income for medical expenses (6% vs 13%). Two years post-PM cessation, more PM children were insured (100% vs 76%). PMs cost $53.05 per child per month, but saved $6045.22 per child insured per year. PMs are more effective than traditional Medicaid/CHIP methods in insuring uninsured minority children, improving health care access, and achieving parental satisfaction, but are inexpensive and highly cost-effective.