HHS/ASPE. U. S. Department of Health and Human Services.background

Designing Subsidized Health Coverage Programs to Attract Enrollment: 
A Review of the Literature and a Synthesis of Stakeholder Views

December, 2008

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This work was sponsored in part by the U.S. Department of Health and Human Services; Don Cox and Don Oellerich serving as contract officers. Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the U.S. Department of Health and Human Services.

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The focus of this study was on the non-price program features that influence the enrollment of non-elderly adults into voluntary state and local programs that subsidize coverage or care.  The study consisted of two Phases -- Phase 1 was a literature review to assess the current state of knowledge regarding the impact of non-price design features on enrollment. Information gathered from this literature was used to inform Phase 2, which consisted of discussions with 67 program directors and other key informants from 17 subsidized coverage programs across the country.  The key findings of the study are as follows:

Programs that target adults directly attract enrollment much more easily than programs that involve employers

Table of Contents

Chapter I

Chapter II

Chapter III

Chapter IV

Chapter V

Chapter VI


Appendix A

  • Study Methodology
  • Programs Included in the Study
  • Logic Model Used to Frame the Analysis
  • Approach to Literature Review
  • Approach to Stakeholder Discussions
  • Data Analysis and Synthesis
  • Quotes in the Report
  • Appendix B

  • Program descriptions
  • (in program name order)
  • Appendix C

  • A Review of SCHIP Literature
  • Background
  • Nonprice Factors Affecting Children’s Enrollment
  • Program Awareness
  • Program Comprehension
  • Program Appeal
  • Collateral Enrollment into Other Coverage Programs

  • How to Obtain a Printed Copy

    To obtain a printed copy of this report, send the title and your mailing information to:

    Policy Information Center, Room 445F
    Assistant Secretary for Planning and Evaluation
    U.S. Department of Health and Human Services
    200 Independence Ave, SW
    Washington, DC 20201

    Fax:  (202) 690-6562
    Email:  pic@hhs.gov

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    Last updated:  04/28/2009