What Factors Affect Voluntary Uptake of Community-Based Health Insurance Schemes in Low- and Middle-Income Countries? A Systematic Review and Meta-Analysis.
What Factors Affect Voluntary Uptake of Community-Based Health Insurance Schemes in Low- and Middle-Income Countries? A Systematic Review and Meta-Analysis.
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DOI：
10.1371/journal.pone.0160479
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Panda PK
中科院分区：
文献类型：
--
作者：
Dror DM;Hossain SA;Majumdar A;Pérez Koehlmoos TL;John D;Panda PK
本研究报告了影响低收入和中等收入国家（LMIC）社区健康保险（chi）计划初始自愿吸收的因素，以及续期决策。按照PRISMA协议，我们对学术文献和灰色文献进行了全面的检索，包括社会科学、经济学和医学的学术数据库（如Econlit、Global health、Medline、Proquest）和其他电子资源（如Eldis和谷歌scholar）。使用特定于数据库的同义词典或索引术语（例如MeSH），结合与chi或健康保险相关的自由文本术语，开发了搜索策略。从2013年5月到2013年11月，用英语、法语、德语和西班牙语进行了搜索。从最初的15770个搜索结果中，保留了54个相关研究来分析影响注册和续订决策的因素。定量综合（通过荟萃分析）和定性分析（通过专题综合）进行比较，以获得对调查结果/陈述的整体综合的见解。meta分析显示，参加家庭健康调查与家庭收入、户主的教育程度和年龄、家庭规模、女性户主、已婚户主和家庭慢性疾病发作呈正相关。专题综合报告表明，下列因素是促进参与的因素：(a)对保险和社区健康的知识和理解，(b)保健质量，(c)对计划管理的信任。妨碍登记的因素包括：(a)不适当的福利待遇；(b)文化信仰；(c)负担能力；(d)与保健设施的距离；(e)缺乏适当的法律和政策框架来支持社区卫生保健计划；以及(f)一些社区卫生保健计划的严格规则。HHH教育程度、家庭规模和对计划管理的信任与成员续期决策呈正相关。其他激励因素包括：(a)对保险和CBHI的认识和理解，(b)医疗保健质量，(c)对计划管理的信任，以及(d)收到上一年的保险赔付。作出续期决定的障碍是：(a)某些CBHI计划的严格规则，(b)支持CBHI计划的法律和政策框架不充分，以及(c)不适当的福利待遇。需求侧因素正向影响儿童健康计划的入学率，包括教育程度、年龄、女性户主和家庭的社会经济地位。此外，当个人了解他们的chi功能时，他们更有可能注册，当人们有积极的索赔体验时，他们更有可能续签。慢性病患病率较高或认为医疗保健质量好且就近是提高入学率的因素。服务距离遥远或缺乏的看法导致入学率下降。第二个观点是，对该计划的信任使报名成为可能。第三，法律或政策框架的明确性是影响入学人数的一个因素。这一点很重要，因为它指出迄今为止尚未发表的证据表明，政府可以通过制定支持性监管和政策规定，有效地扩大其与被排除在社会保护之外的基层群体的联系，即使它们无法全额资助这类计划，也可以利用人们自愿和缴费参加社区健康保险的意愿。
This research article reports on factors influencing initial voluntary uptake of community-based health insurance (CBHI) schemes in low- and middle-income countries (LMIC), and renewal decisions. Following PRISMA protocol, we conducted a comprehensive search of academic and gray literature, including academic databases in social science, economics and medical sciences (e.g., Econlit, Global health, Medline, Proquest) and other electronic resources (e.g., Eldis and Google scholar). Search strategies were developed using the thesaurus or index terms (e.g., MeSH) specific to the databases, combined with free text terms related to CBHI or health insurance. Searches were conducted from May 2013 to November 2013 in English, French, German, and Spanish. From the initial search yield of 15,770 hits, 54 relevant studies were retained for analysis of factors influencing enrolment and renewal decisions. The quantitative synthesis (informed by meta-analysis) and the qualitative analysis (informed by thematic synthesis) were compared to gain insight for an overall synthesis of findings/statements. Meta-analysis suggests that enrolments in CBHI were positively associated with household income, education and age of the household head (HHH), household size, female-headed household, married HHH and chronic illness episodes in the household. The thematic synthesis suggests the following factors as enablers for enrolment: (a) knowledge and understanding of insurance and CBHI, (b) quality of healthcare, (c) trust in scheme management. Factors found to be barriers to enrolment include: (a) inappropriate benefits package, (b) cultural beliefs, (c) affordability, (d) distance to healthcare facility, (e) lack of adequate legal and policy frameworks to support CBHI, and (f) stringent rules of some CBHI schemes. HHH education, household size and trust in the scheme management were positively associated with member renewal decisions. Other motivators were: (a) knowledge and understanding of insurance and CBHI, (b) healthcare quality, (c) trust in scheme management, and (d) receipt of an insurance payout the previous year. The barriers to renewal decisions were: (a) stringent rules of some CBHI schemes, (b) inadequate legal and policy frameworks to support CBHI and (c) inappropriate benefits package. The demand-side factors positively affecting enrolment in CBHI include education, age, female household heads, and the socioeconomic status of households. Moreover, when individuals understand how their CBHI functions they are more likely to enroll and when people have a positive claims experience, they are more likely to renew. A higher prevalence of chronic conditions or the perception that healthcare is of good quality and nearby act as factors enhancing enrolment. The perception that services are distant or deficient leads to lower enrolments. The second insight is that trust in the scheme enables enrolment. Thirdly, clarity about the legal or policy framework acts as a factor influencing enrolments. This is significant, as it points to hitherto unpublished evidence that governments can effectively broaden their outreach to grassroots groups that are excluded from social protection by formulating supportive regulatory and policy provisions even if they cannot fund such schemes in full, by leveraging people’s willingness to exercise voluntary and contributory enrolment in a community-based health insurance.
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影响因子：
3
作者：
Akotey, Oscar Joseph;Osei, Kofi A.;Gemegah, Albert
通讯作者：
Gemegah, Albert
影响因子：
2.8
作者：
Basaza RK;Criel B;Van der Stuyft P
通讯作者：
Van der Stuyft P
影响因子：
3.3
作者：
Basaza, Robert;Criel, Bart;Van der Stuyft, Patrick
通讯作者：
Van der Stuyft, Patrick
DOI：
10.5539/jsd.v4n5p125
发表时间：
2011-01-01
期刊：
Journal of Sustainable Development
影响因子：
--
作者：
Alatinga, K.;Fielmua, N.
通讯作者：
Fielmua, N.
影响因子：
2.8
作者：
Basaza, Robert;Criel, Bart;Van der Stuyft, Patrick
通讯作者：
Van der Stuyft, Patrick