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- Title
The impact of health insurance in Africa and Asia: a systematic review.
- Authors
Spaan, Ernst; Mathijssen, Judith; Tromp, Noor; McBain, Florence; ten Have, Arthur; Baltussen, Rob
- Abstract
Objective To evaluate the impact of health insurance on resource mobilization, financial protection, service utilization, quality of care, social inclusion and community empowerment in low- and lower-middle-income countries in Africa and Asia. Methods A systematic search for randomized controlled trials, quasi-experimental and observational studies published before the end of 2011 was conducted in 20 literature databases, reference lists of relevant studies, web sites and the grey literature. Study quality was assessed with a quality grading protocol. Findings Inclusion criteria were met by 159 studies - 68 in Africa and 91 in Asia. Most African studies reported on community-based health insurance (CBHI) and were of relatively high quality; social health insurance (SHI) studies were mostly Asian and of medium quality. Only one Asian study dealt with private health insurance (PHI). Most studies were observational; four had randomized controls and 20 had a quasi-experimental design. Financial protection, utilization and social inclusion were far more common subjects than resource mobilization, quality of care or community empowerment. Strong evidence shows that CBHI and SHI improve service utilization and protect members financially by reducing their out-of-pocket expenditure, and that CBHI improves resource mobilization too. Weak evidence points to a positive effect of both SHI and CBHI on quality of care and social inclusion. The effect of SHI and CBHI on community empowerment is inconclusive. Findings for PHI are inconclusive in all domains because of insufficient studies. Conclusion Health insurance offers some protection against the detrimental effects of user fees and a promising avenue towards universal health-care coverage.
- Subjects
AFRICA; ASIA; INFORMATION storage &; retrieval systems; MEDICAL databases; HEALTH insurance; MEDICAL care; MEDICAL care costs; MEDLINE; ONLINE information services; RESEARCH funding; SYSTEMATIC reviews; BIBLIOGRAPHIC databases
- Publication
Bulletin of the World Health Organization, 2012, Vol 90, Issue 9, p685
- ISSN
0042-9686
- Publication type
Article
- DOI
10.2471/BLT.12.102301