Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Aug 10:44:1605749.
doi: 10.3389/phrs.2023.1605749. eCollection 2023.

Effects of Health Insurance on Quality of Care in Low-Income Countries: A Systematic Review

Doris Osei Afriyie  1   2 , Brendan Kwesiga  3 , Grace Achungura  4 , Fabrizio Tediosi  1   2 , Günther Fink  1   2
Affiliations
Review

Effects of Health Insurance on Quality of Care in Low-Income Countries: A Systematic Review

Doris Osei Afriyie et al. Public Health Rev. .

Abstract

Objectives: To evaluate the effectiveness of health insurance on quality of care in low-income countries (LICs). Methods: We conducted a systematic review following PRISMA guidelines. We searched seven databases for studies published between 2010 and August 2022. We included studies that evaluated the effects of health insurance on quality of care in LICs using randomized experiments or quasi-experimental study designs. Study outcomes were classified using the Donabedian framework. Results: We included 15 studies out of the 6,129 identified. Available evidence seems to suggest that health insurance has limited effects on structural quality, and its effects on the process of care remain mixed. At the population level, health insurance is linked to improved anthropometric measures for children and biomarkers such as blood pressure and hemoglobin levels. Conclusion: Based on the currently available evidence, it appears that health insurance in LICs has limited effects on the quality of care. Further studies are required to delve into the mechanisms that underlie the impact of health insurance on the quality of care and identify the most effective strategies to ensure quality within insurance programs. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=219984, identifier PROSPERO CRD42020219984.

Keywords: health insurance; low-income; quality of care; systematic review; universal health coverage.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they do not have any conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart of included studies (Health insurance and Quality of care in low-income countries, 2010–2022).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. United Nations General Assembly. Resolution Adopted by the General Assembly on 12 December 2017. New York, NY: United Nations General Assembly; (2012).
    1. Kieny MP, Bekedam H, Dovlo D, Fitzgerald J, Habicht J, Harrison G, et al. Strengthening Health Systems for Universal Health Coverage and Sustainable Development. Bull World Health Organ (2017) 95(7):537–9. 10.2471/BLT.16.187476 - DOI - PMC - PubMed
    1. World Health Organization. The World Health Report: Health Systems Financing: The Path to Universal Coverage. Geneva: World Health Organization; (2010). - PMC - PubMed
    1. van Hees SGM, O'Fallon T, Hofker M, Dekker M, Polack S, Banks LM, et al. Leaving No One Behind? Social Inclusion of Health Insurance in Low- and Middle-Income Countries: A Systematic Review. Int J Equity Health (2019) 18:134. 10.1186/s12939-019-1040-0 - DOI - PMC - PubMed
    1. Docrat S, Besada D, Cleary S, Lund C. The Impact of Social, National and Community-Based Health Insurance on Health Care Utilization for Mental, Neurological and Substance-Use Disorders in Low-And Middle-Income Countries: A Systematic Review. Health Econ Rev (2020) 10:11. 10.1186/s13561-020-00268-x - DOI - PMC - PubMed