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Meta-Analysis
. 2014 Nov 26;2014(11):CD008194.
doi: 10.1002/14651858.CD008194.pub3.

Strategies for expanding health insurance coverage in vulnerable populations

Liying Jia  1 , Beibei Yuan, Fei Huang, Ying Lu, Paul Garner, Qingyue Meng
Affiliations
Meta-Analysis

Strategies for expanding health insurance coverage in vulnerable populations

Liying Jia et al. Cochrane Database Syst Rev. .

Abstract

Background: Health insurance has the potential to improve access to health care and protect people from the financial risks of diseases. However, health insurance coverage is often low, particularly for people most in need of protection, including children and other vulnerable populations.

Objectives: To assess the effectiveness of strategies for expanding health insurance coverage in vulnerable populations.

Search methods: We searched Cochrane Central Register of Controlled Trials (CENTRAL), part of The Cochrane Library. www.thecochranelibrary.com (searched 2 November 2012), PubMed (searched 1 November 2012), EMBASE (searched 6 July 2012), Global Health (searched 6 July 2012), IBSS (searched 6 July 2012), WHO Library Database (WHOLIS) (searched 1 November 2012), IDEAS (searched 1 November 2012), ISI-Proceedings (searched 1 November 2012),OpenGrey (changed from OpenSIGLE) (searched 1 November 2012), African Index Medicus (searched 1 November 2012), BLDS (searched 1 November 2012), Econlit (searched 1 November 2012), ELDIS (searched 1 November 2012), ERIC (searched 1 November 2012), HERDIN NeON Database (searched 1 November 2012), IndMED (searched 1 November 2012), JSTOR (searched 1 November 2012), LILACS(searched 1 November 2012), NTIS (searched 1 November 2012), PAIS (searched 6 July 2012), Popline (searched 1 November 2012), ProQuest Dissertation &Theses Database (searched 1 November 2012), PsycINFO (searched 6 July 2012), SSRN (searched 1 November 2012), Thai Index Medicus (searched 1 November 2012), World Bank (searched 2 November 2012), WanFang (searched 3 November 2012), China National Knowledge Infrastructure (CHKD-CNKI) (searched 2 November 2012).In addition, we searched the reference lists of included studies and carried out a citation search for the included studies via Web of Science to find other potentially relevant studies.

Selection criteria: Randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA) studies and Interrupted time series (ITS) studies that evaluated the effects of strategies on increasing health insurance coverage for vulnerable populations. We defined strategies as measures to improve the enrolment of vulnerable populations into health insurance schemes. Two categories and six specified strategies were identified as the interventions.

Data collection and analysis: At least two review authors independently extracted data and assessed the risk of bias. We undertook a structured synthesis.

Main results: We included two studies, both from the United States. People offered health insurance information and application support by community-based case managers were probably more likely to enrol their children into health insurance programmes (risk ratio (RR) 1.68, 95% confidence interval (CI) 1.44 to 1.96, moderate quality evidence) and were probably more likely to continue insuring their children (RR 2.59, 95% CI 1.95 to 3.44, moderate quality evidence). Of all the children that were insured, those in the intervention group may have been insured quicker (47.3 fewer days, 95% CI 20.6 to 74.0 fewer days, low quality evidence) and parents may have been more satisfied on average (satisfaction score average difference 1.07, 95% CI 0.72 to 1.42, low quality evidence).In the second study applications were handed out in emergency departments at hospitals, compared to not handing out applications, and may have had an effect on enrolment (RR 1.5, 95% CI 1.03 to 2.18, low quality evidence).

Authors' conclusions: Community-based case managers who provide health insurance information, application support, and negotiate with the insurer probably increase enrolment of children in health insurance schemes. However, the transferability of this intervention to other populations or other settings is uncertain. Handing out insurance application materials in hospital emergency departments may help increase the enrolment of children in health insurance schemes. Further studies evaluating the effectiveness of different strategies for expanding health insurance coverage in vulnerable population are needed in different settings, with careful attention given to study design.

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Conflict of interest statement

There are no conflicts of interest.

Figures

1
1
Study flow diagram.
2
2
Study flow diagram for the previous version of the review (Meng 2010b).
3
3
Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
4
4
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
1.1
1.1. Analysis
Comparison 1 Awareness and application support versus no intervention, Outcome 1 Enrolment.
1.2
1.2. Analysis
Comparison 1 Awareness and application support versus no intervention, Outcome 2 Continuous enrolment.
1.3
1.3. Analysis
Comparison 1 Awareness and application support versus no intervention, Outcome 3 Sporadic enrolment.
1.4
1.4. Analysis
Comparison 1 Awareness and application support versus no intervention, Outcome 4 Mean time to obtain insurance.
1.5
1.5. Analysis
Comparison 1 Awareness and application support versus no intervention, Outcome 5 Parental satisfaction with process of enrolment.
2.1
2.1. Analysis
Comparison 2 Handing out applications versus no intervention, Outcome 1 Enrolment.
See this image and copyright information in PMC

Update of

References

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References to other published versions of this review

Meng 2010b
    1. Qingyue Meng, Beibei Yuan, Liying Jia, Jian Wang, Paul Garner. Outreach strategies for expanding health insurance coverage in children. Cochrane Database of Systematic Reviews 2010, Issue 8. [DOI: 10.1002/14651858.CD008194.pub2] - DOI - PubMed

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