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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
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
Public Health 85(10), pp. 1412-1417.
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