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Family Health

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Outreach efforts produce only minimal increases in preventive health screenings among poor children

In most States, fewer than half of poor children insured by Medicaid receive regular health checkups, and in four States, fewer than 20 percent receive them. These screenings include important immunizations against serious diseases as well as regular health care. What will motivate poor parents to obtain these health checkups for their children? Apparently it will take more than pamphlets, phone calls, and home visits from a nurse, according to a recent study supported by the Agency for Health Care Policy and Research (HS06507).

Maija Selby-Harrington, Dr.P.H., R.N., and colleagues at the University of North Carolina evaluated three ways to increase use of the Early and Periodic Screening, Diagnosis, and Treatment Program for Medicaid-eligible children among 2,053 families in six medically underserved rural counties of North Carolina from 1990 through 1992. The families were randomly assigned to one of these outreach efforts: one, a mailed pamphlet and letter; two, a phone call; or three, a home visit by a nurse; or to the control effort, the usual method of informing parents about the need for these screenings when they apply for Medicaid insurance and at yearly reviews. All families received the control method, but families in the control group received only this method.

The outreach communications emphasized the importance of regular screening checkups for children, identified the children needing checkups, and provided phone numbers for making appointments and obtaining transpor-tation assistance. For families with a phone, a phone call was the most cost-effective intervention, with a cost of $137 per added health screening. For no-phone families (30-55 percent), a pamphlet/letter was most cost-effective, at $91 per added screening. At best, the most effective intervention,a home visit(at a cost of $306 per added screening),produced screenings for only 16 with-phone families per 100 visits compared with 5 per 100 for the control method. Although statistically significant, the overall effects were small.

The researchers point out that although new outreach methods are needed and existing methods should be improved, their findings suggest that system-level changes may be necessary to enable families to use Medicaid health services. In particular, they point to the disruptions in Medicaid eligibility encountered by nearly 20 percent of the families in this study, system-wide health care delivery problems in some areas, poverty-level life stresses, and barriers encountered by families attempting to access "free" health screenings.

For details, see "Increasing Medicaid child health screenings: The effectiveness of mailed pamphlets, phone calls, and home visits," by Dr. Selby-Harrington, James R. Sorenson, Ph.D., Dana Quade, Ph.D., and others, in the October 1995 American Journal of Public Health 85(10), pp. 1412-1417.

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