Cost-Effectiveness of Insuring the Uninsured: The Case of Korean American Children

Background. More than one quarter of Korean American children are uninsured, and many are eligible for children's health insurance programs. The objective of this study is to evaluate the effectiveness and cost-effectiveness of different school-based health insurance strategies to provide coverage to uninsured Korean American children. Method. The authors used a quasi-experimental nonequivalent control group design, conducted from July to December 2005 in Los Angeles, California. The subjects were Korean American children in 3 groups/schools (n=1181). Parents received a variation of outreach methods (i.e., information sheets, school site presentations, automated telephone messages, personal telephone calls) and application assistance (i.e., telephone helpline, on-site assistance). The authors used bivariate and multivariable analysis to assess effectiveness. Cost-effectiveness was performed using a 3-stage model and Monte Carlo simulation. Results. Of the uninsured in the intensive intervention group, 41% applied for insurance compared with 13% of the control group (P=0.002). This success was due to personal telephone calls. Of the uninsured in the intensive intervention group, 23% enrolled in insurance compared with 10% of the control group (P=0.048). The most common reason reported by parents for nonenrollment despite assistance was failure to mail in the application. Despite the small increase in insurance enrollment from the intensive intervention strategy compared with the control group, it is cost-effective. Conclusions. Personal telephone calls are effective in increasing outreach for children's health insurance application. However, more research is needed to investigate why parents fail to mail in the application. Ultimately, insuring more children will result in cost-effective improvements in quality-adjusted life years.