A new review of existing research suggests that health system workers can boost the number of children with medical insurance by providing application materials to parents and helping them fill out the forms.
The number of studies in the Cochrane Library review is small: researchers could only find two that met their criteria after they examined 89 studies from around the world.
Even so, the two studies "suggest that in certain settings, active outreach may enhance the ability of kids to get health insurance," said Paul Wise, a professor of child health and society at Stanford University who is familiar with the review findings. "It's always been a suspicion and people tend to just accept it. But this analysis helps document that."
According to the review, children often go without insurance both in developing countries and developed countries like the United States that don't have universal health coverage.
A 2006 study estimated that 11.2 percent of children in the United States did not have health insurance. Some of these children do not get routine checkups or immunizations and do not have a primary doctor. Studies have suggested that their overall health is poorer than that of other kids.
Most of the time, the uninsured children are eligible for some sort of insurance coverage, Wise said. However, their parents might not know they are eligible or think the costs are too high.
Alternatively, there might simply be too many obstacles to overcome to get coverage, he said. In some cases, "they have to fill out all kinds of paperwork, show up in person and give documentation of income and assets. Parents may be working two jobs, and when these offices are open nine to five, it's impossible to get these kids signed up."
Other challenges crop up too, said Shana Alex Lavarreda, director of health insurance studies at the UCLA Center for Health Policy Research.
"One significant barrier is whether or not the parents and other members of the family − such as noncitizen siblings − are also eligible for enrollment in public coverage. When the entire family can't get coverage or the parents are uninsured, it makes it very difficult to motivate enrollment and to provide the knowledge on how to navigate the system," Lavarreda said.
The new review examines research that analyzed ways to encourage more parents to sign up for insurance for their kids.
The review was published by The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
The researchers, from China and Britain, only found two studies that they thought addressed the topic adequately. Both were from the United States.
Why are there so few studies? "Most efforts have been to create programs that make children eligible," Wise said. "There's been less work on how to make kids who are eligible actually get into the programs."
In one study, from 2005, researchers assigned the families of uninsured Latino children randomly to one of two groups. In one group, case managers helped the parents fill out forms and acted as advocates for them when they had to deal with the state.
In the other group, researchers contacted the parents once a month for 11 months about health insurance.
The researchers found that the parents who got assistance were 1.7 times more likely to get coverage (96 percent of them did) and 2.6 times more likely to stick with the insurance (78 percent of them did) than those who did not get assistance.
In the other study, also from 2005, researchers assigned 223 uninsured children in emergency rooms in four cities to one of two groups. In one group, workers handed out insurance applications to the children. The other group did not get the applications.
After about 90 days, those who received the applications were 1.5 times more likely to have insurance through programs for the poor (42 percent of them were) compared to the other kids.
The review authors write, "Both measures appeared to be effective."
Lavarreda, the UCLA researcher, said the review authors were too limited about the studies they chose to include, missing others in "the entire body of literature devoted to this topic."
She added that the findings do not add much to existing knowledge, although they do spotlight the lack of randomized controlled trials − considered the gold standard of medical and social research − in this area.
In the big picture, she said, the existing research does support interventions designed to help more kids gain insurance coverage.
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