The impact of vouchers on the use and quality of health care in developing countries: A systematic review
The impact of vouchers on the use and quality of health care in developing countries: A systematic review
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DOI：
10.1080/17441692.2012.759254
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发表时间：
2013-04-01
影响因子：
3.3
通讯作者：
Potts, Malcom
中科院分区：
文献类型：
--
作者：
Brody, Carinne Meyer;Bellows, Nicole;Potts, Malcom
在发展中国家提供医疗保健的一种方法是通过代金券计划，向目标人群分发代金券，以获得免费或补贴的医疗保健。使用入选/排除标准，于2010年10月进行了数据库检索、关键期刊和网站审查。采用叙述性综合方法总结和分析了五个结果类别：目标确定、利用、成本效益、质量和健康结果。还进行了亚组和敏感性分析。共确定了24项研究，对16个保健券方案进行了评价。64个结果变量的结果表明：适度的证据表明，代金券有效地针对特定人群;没有足够的证据来确定代金券是否有效地提供医疗保健;有力的证据表明代金券提高了利用率;适度的证据表明代金券提高了质量;没有证据表明代金券对健康结果有影响;然而，在敏感性分析中发现最后一个结论是不稳定的。在目标确定、利用和质量方面的结果表明，医疗券对提供保健服务有积极影响。从分析的数据中发现，它们改善健康的后续联系是不稳定的;另一个积极影响的发现将产生强有力的证据。研究人员仍然是新的，发表的研究数量有限。
One approach to delivering healthcare in developing countries is through voucher programmes, where vouchers are distributed to a targeted population for free or subsidised health care. Using inclusion/exclusion criteria, a search of databases, key journals and websites review was conducted in October 2010. A narrative synthesis approach was taken to summarise and analyse five outcome categories: targeting, utilisation, cost efficiency, quality and health outcomes. Sub-group and sensitivity analyses were also performed. A total of 24 studies evaluating 16 health voucher programmes were identified. The findings from 64 outcome variables indicates: modest evidence that vouchers effectively target specific populations; insufficient evidence to determine whether vouchers deliver healthcare efficiently; robust evidence that vouchers increase utilisation; modest evidence that vouchers improve quality; no evidence that vouchers have an impact on health outcomes; however, this last conclusion was found to be unstable in a sensitivity analysis. The results in the areas of targeting, utilisation and quality indicate that vouchers have a positive effect on health service delivery. The subsequent link that they improve health was found to be unstable from the data analysed; another finding of a positive effect would result in robust evidence. Vouchers are still new and the number of published studies is limiting.