A Text Message Outreach Intervention to Increase Health Insurance Enrollment for Self-Pay Patients

Bibliographic Data

ID9101664
AuthorsYan Lu (0000-0002-6757-5533, JPS Health Network, corresponding author), Kevin J Craten (0000-0003-0469-4217, JPS Health Network, corresponding author), Caitlin T Thompson (JPS Health Network, corresponding author), Robert Scroggins (Business Intelligence, JPS Health Network, Fort Worth, TX), Robert C Scroggins (JPS Health Network), Jeff Claassen (JPS Health Network, corresponding author), Joshua Manning (Business Intelligence, JPS Health Network, Fort Worth, TX), Rohit P Ojha (0000-0003-0595-8990, JPS Health Network, corresponding author)
Year2025
Volume63
Issue8
Pages600-605
Publication date2025-08-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000002157
PMID40730237
OpenAlexW4410092299
LanguageEN
References cited26

BACKGROUND: Self-pay patients may be unaware of their eligibility for health insurance coverage through government or hospital-based medical assistance programs. OBJECTIVES: We aimed to evaluate the effect of behaviorally informed text message outreach on insurance enrollment among self-pay patients discharged from the emergency department (ED) at a safety-net hospital. RESEARCH DESIGN: We emulated a single-arm trial with a historical comparison. Our eligible population included self-pay ED patients aged 18-64 years who were discharged between October 31 and November 24, 2022 (outreach group) or between April 1 and July 31, 2022 (historical comparison). We used entropy balancing weights to adjust for baseline characteristics and estimated overall and race/ethnicity-specific risk ratios (RR), risk differences (RD), and 95% confidence limits (CL) for the effect of the text outreach on insurance enrollment. RESULTS: The study population comprised 748 patients in the intervention and 6199 in the comparison group. The median age was 36 years (interquartile range=28-47), 58% were male, and 65% were racial/ethnic minorities. Overall outreach effect on any coverage enrollment (RR=1.4, 95% CL: 1.2, 1.6; RD=7.1%, 95% CL: 3.7%, 10%) was larger than the effect on hospital-based medical assistance program and Medicaid enrollment (RR=1.2, 95% CL: 1.0, 1.4; RD=2.7%, 95% CL: -0.24%, 5.7%). The latter effect was largest in the Hispanic population. CONCLUSIONS: Our results suggest behaviorally informed text outreach increases insurance enrollment among self-pay patients discharged from the ED at a safety-net hospital and may complement broader strategies to increase health insurance enrollment. Future studies should compare different text message strategies

Confidence interval · Emergency department · Environmental health · Ethnic group · Family medicine · Health care · Interquartile range · Medicaid · Outreach · Political science · Population · Chronic Disease Management Strategies · Demography · Healthcare Policy and Management · Internal Medicine · Medication Adherence and Compliance · Medicine · Nursing

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