Lagarde Mylene, Haines Andy, Palmer Natasha
Health Policy Unit, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK, WC1E 7HT.
Cochrane Database Syst Rev. 2009 Oct 7;2009(4):CD008137. doi: 10.1002/14651858.CD008137.
Conditional cash transfers (CCT) provide monetary transfers to households on the condition that they comply with some pre-defined requirements. CCT programmes have been justified on the grounds that demand-side subsidies are necessary to address inequities in access to health and social services for poor people. In the past decade they have become increasingly popular, particularly in middle income countries in Latin America.
To assess the effectiveness of CCT in improving access to care and health outcomes, in particular for poorer populations in low and middle income countries.
We searched a wide range of international databases, including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE, in addition to development studies and economic databases. We also searched the websites and online resources of numerous international agencies, organisations and universities to find relevant grey literature. The original searches were conducted between November 2005 and April 2006. An updated search in MEDLINE was carried out in May 2009.
CCT were defined as monetary transfers made to households on the condition that they comply with some pre-determined requirements in relation to health care. Studies had to include an objective measure of at least one of the following outcomes: health care utilisation, health expenditure, health outcomes or equity outcomes. Eligible study designs were: randomised controlled trial, interrupted time series analysis, or controlled before-after study of the impact of health financing policies following criteria used by the Cochrane Effective Practice and Organisation of Care Group.
We performed qualitative analysis of the evidence.
We included ten papers reporting results from six intervention studies. Overall, design quality and analysis limited the risks of bias. Several CCT programmes provided strong evidence of a positive impact on the use of health services, nutritional status and health outcomes, respectively assessed by anthropometric measurements and self-reported episodes of illness. It is hard to attribute these positive effects to the cash incentives specifically because other components may also contribute. Several studies provide evidence of positive impacts on the uptake of preventive services by children and pregnant women. We found no evidence about effects on health care expenditure.
AUTHORS' CONCLUSIONS: Conditional cash transfer programmes have been the subject of some well-designed evaluations, which strongly suggest that they could be an effective approach to improving access to preventive services. Their replicability under different conditions - particularly in more deprived settings - is still unclear because they depend on effective primary health care and mechanisms to disburse payments. Further rigorous evaluative research is needed, particularly where CCTs are being introduced in low income countries, for example in Sub-Saharan Africa or South Asia.
有条件现金转移支付（CCT）向家庭提供货币转移支付，条件是这些家庭要符合一些预先确定的要求。CCT项目的正当理由是，需求侧补贴对于解决穷人在获得卫生和社会服务方面的不平等现象是必要的。在过去十年中，它们越来越受欢迎，尤其是在拉丁美洲的中等收入国家。
评估CCT在改善获得医疗服务的机会和健康结果方面的有效性，特别是对低收入和中等收入国家的贫困人口而言。
我们检索了广泛的国际数据库，包括Cochrane对照试验中心注册库（CENTRAL）、MEDLINE和EMBASE，此外还检索了发展研究和经济数据库。我们还搜索了众多国际机构、组织和大学的网站及在线资源，以查找相关的灰色文献。最初的检索在2005年11月至2006年4月期间进行。2009年5月在MEDLINE中进行了更新检索。
CCT被定义为在家庭符合与医疗保健相关的一些预先确定的要求的条件下向其提供的货币转移支付。研究必须包括对以下至少一项结果的客观测量：医疗服务利用、医疗支出、健康结果或公平性结果。符合条件的研究设计为：随机对照试验、中断时间序列分析，或按照Cochrane有效实践与护理组织小组使用的标准对卫生筹资政策影响进行的前后对照研究。
我们对证据进行了定性分析。
我们纳入了十篇报告六项干预研究结果的论文。总体而言，设计质量和分析限制了偏倚风险。几个CCT项目提供了有力证据，表明分别通过人体测量和自我报告的疾病发作情况评估，对卫生服务利用、营养状况和健康结果产生了积极影响。很难将这些积极影响具体归因于现金激励措施，因为其他因素也可能有贡献。几项研究提供了对儿童和孕妇预防性服务利用产生积极影响的证据。我们没有发现关于对医疗支出影响的证据。
有条件现金转移支付项目已经成为一些精心设计评估的主题，这些评估有力地表明它们可能是改善获得预防性服务机会的有效方法。它们在不同条件下——特别是在更贫困环境中——的可复制性仍不明确，因为它们依赖有效的初级卫生保健和支付发放机制。需要进一步进行严格的评估研究，特别是在低收入国家引入CCT的地方，例如在撒哈拉以南非洲或南亚。
