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学科主题: 公共卫生
题名:
Strategies for expanding health insurance coverage in vulnerable populations
作者: Jia, Liying1,2; Yuan, Beibei3; Huang, Fei1; Lu, Ying1; Garner, Paul4; Meng, Qingyue3
关键词: Documentation [methods] ; Emergency Service, Hospital ; Insurance Coverage [organization & ; administration ; statistics & ; numerical data] ; Insurance, Health [organization& ; administration ; statistics & ; numerical data] ; Latin America [ethnology] ; Medically Uninsured [statistics & ; numerical data] ; Randomized Controlled Trials as Topic ; United States ; Adolescent ; Child ; Humans
刊名: COCHRANE DATABASE OF SYSTEMATIC REVIEWS
发表日期: 2014
DOI: 10.1002/14651858.CD008194.pub3
期: 11
收录类别: SCI ; SSCI
文章类型: Review
WOS标题词: Science & Technology
类目[WOS]: Medicine, General & Internal
研究领域[WOS]: General & Internal Medicine
关键词[WOS]: UNINSURED CHILDREN ; TAKE-UP ; EMERGENCY-DEPARTMENT ; MEDICAID ELIGIBILITY ; LATINO CHILDREN ; INCOME CHILDREN ; PREGNANT-WOMEN ; CROWD-OUT ; NEW-YORK ; PROGRAM
英文摘要:

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 1November 2012), OpenGrey (changed fromOpenSIGLE) (searched 1November 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

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.

语种: 英语
项目资助者: Shandong University ; Peking University ; Alliance for Health Policy and Systems Research, World Health Organization, Switzerland ; Norwegian Satellite of the Cochrane Effective Practice and Organisation of Care Group, Norway ; Effective Health Care Research Consortium by Department for International Development, UK
WOS记录号: WOS:000347646200026
Citation statistics:
内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/123504
Appears in Collections:北京大学中国卫生发展研究中心_期刊论文

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作者单位: 1.Shandong Univ, Ctr Hlth Management & Policy, Jinan 250100, Peoples R China
2.Minist Hlth, Key Lab Hlth Econ & Policy Res, Jinan, Shandong, Peoples R China
3.Peking Univ, CCHDS, Beijing 100191, Peoples R China
4.Univ Liverpool, Liverpool Sch Trop Med, Dept Clin Sci, Liverpool L3 5QA, Merseyside, England

Recommended Citation:
Jia, Liying,Yuan, Beibei,Huang, Fei,et al. Strategies for expanding health insurance coverage in vulnerable populations[J]. COCHRANE DATABASE OF SYSTEMATIC REVIEWS,2014(11).
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