Pilot intervention

In autumn 2019, the CM region Antwerp-Mechelen-Turnhout commissioned the pilot intervention 'Proactive Increased Reimbursement' (further VT). VT ensures that health care costs are reduced for people with a low income or who meet certain conditions. This right is not always automatically granted to those who are entitled to it. As a result, there are many citizens who do not take advantage of VT. With this study, CM wanted to see if they could ensure that those who meet the conditions for the increased allowance could actually claim it.

CM methodology before the pilot

To maximise eligibility for VT, CM staff contacted their members on their own initiative. They did this by

•     with families where they suspected that the family income had decreased due to a change in the social security status of one of the family members.
•     with specific groups that CM suspects are vulnerable because of their low income, such as the long-term unemployed and single-parent families.

Based on these indicators, members are selected from their databases and letters are sent. The letter informs the member of the increased allowance and the associated benefits, and invites them to carry out an income check or to visit the office by appointment. Every quarter, all 'new' potential beneficiaries receive such a letter. Each time, a limited number of members apply to have their eligibility checked.

Methodology of the pilot intervention

In this project, this letter was followed by a telephone contact. It was hoped that this additional moment of communication would help to increase the take-up of VT eligibility among specific, vulnerable groups. Previous research has shown that letters are not always opened, that not everyone has the same level of literacy and language skills, and that there is often a gap between intending to complete the accompanying income survey and actually making an appointment to do so.

This limited pilot study therefore investigated the extent to which telephone follow-up with potentially eligible persons who had already received a letter would increase the number of VT claims granted. It was also important to see whether certain target groups would benefit more or less from such a telephone follow-up.

Sending letters based on indicators in the CM databases ensures that about 10% of those potentially eligible will eventually apply for and receive the right to VT. We see this in both the control and experimental groups. Based on the additional screening and telephone follow-up, a small but limited group of about 4% is additionally granted the right to VT. This is a limited but still significant effect of the telephone follow-up. The final numbers are too small to substantiate this in analyses, but it seems that it is mainly the long-term unemployed and single-parent families who benefit from this telephone follow-up.

Who was called?

The letter that CM sends to members on the basis of certain indicators can be seen as casting a wide net. In reality, this letter also reaches many households that are not eligible for VT. The first stage of the telephone contact screening process is to filter out from the list of members to be called those for whom VT has already been granted or for whom an appointment has already been made. In the second stage, family situation, income and other factors are checked in the member's own CM data. If these showed that the member was not eligible for VT, the member was not called. Throughout the field trial, this resulted in a significant group being marked as 'ineligible'. Subsequently, it appears that almost two out of three of those called have incomes too high to qualify for VT.

If most of these can be identified during the preparation phase of the telephone contact, this means that a telephone follow-up could be useful for about a third of the members who received a letter.