Prinja Shankar, Chauhan Akashdeep Singh, Karan Anup, Kaur Gunjeet, Kumar Rajesh
School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Indian Institute of Public Health, Delhi, Public Health Foundation of India, Delhi NCR, India.
PLoS One. 2017 Feb 2;12(2):e0170996. doi: 10.1371/journal.pone.0170996. eCollection 2017.
Several publicly financed health insurance schemes have been launched in India with the aim of providing universalizing health coverage (UHC). In this paper, we report the impact of publicly financed health insurance schemes on health service utilization, out-of-pocket (OOP) expenditure, financial risk protection and health status. Empirical research studies focussing on the impact or evaluation of publicly financed health insurance schemes in India were searched on PubMed, Google scholar, Ovid, Scopus, Embase and relevant websites. The studies were selected based on two stage screening PRISMA guidelines in which two researchers independently assessed the suitability and quality of the studies. The studies included in the review were divided into two groups i.e., with and without a comparison group. To assess the impact on utilization, OOP expenditure and health indicators, only the studies with a comparison group were reviewed. Out of 1265 articles screened after initial search, 43 studies were found eligible and reviewed in full text, finally yielding 14 studies which had a comparator group in their evaluation design. All the studies (n-7) focussing on utilization showed a positive effect in terms of increase in the consumption of health services with introduction of health insurance. About 70% studies (n-5) studies with a strong design and assessing financial risk protection showed no impact in reduction of OOP expenditures, while remaining 30% of evaluations (n-2), which particularly evaluated state sponsored health insurance schemes, reported a decline in OOP expenditure among the enrolled households. One study which evaluated impact on health outcome showed reduction in mortality among enrolled as compared to non-enrolled households, from conditions covered by the insurance scheme. While utilization of healthcare did improve among those enrolled in the scheme, there is no clear evidence yet to suggest that these have resulted in reduced OOP expenditures or higher financial risk protection.
印度已经推出了几个公共资助的医疗保险计划，旨在实现全民健康覆盖（UHC）。在本文中，我们报告了公共资助的医疗保险计划对医疗服务利用、自付费用（OOP）、财务风险保护和健康状况的影响。我们在PubMed、谷歌学术、Ovid、Scopus、Embase和相关网站上搜索了聚焦于印度公共资助医疗保险计划影响或评估的实证研究。这些研究是根据两阶段筛选的PRISMA指南进行选择的，其中两名研究人员独立评估研究的适用性和质量。纳入综述的研究分为两组，即有对照组和无对照组。为了评估对利用、OOP支出和健康指标的影响，仅对有对照组的研究进行了综述。在初步搜索后筛选的1265篇文章中，发现43项研究符合条件并进行了全文综述，最终有14项研究在其评估设计中有比较组。所有关注利用情况的研究（n = 7）均表明，引入医疗保险后，医疗服务消费增加，产生了积极影响。约70%设计严谨且评估财务风险保护的研究（n = 5）表明，在降低OOP支出方面没有影响，而其余30%的评估（n = 2），特别是评估国家资助医疗保险计划的评估，报告参保家庭的OOP支出有所下降。一项评估对健康结果影响的研究表明，与未参保家庭相比，参保家庭中因保险计划涵盖疾病导致的死亡率有所降低。虽然参保者的医疗保健利用率确实有所提高，但尚无明确证据表明这些措施导致了OOP支出的减少或更高的财务风险保护。
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