Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA.
Stanford University School of Medicine, Palo Alto, California, USA.
J Glob Health. 2018 Dec;8(2):020402. doi: 10.7189/jogh.08.020402.
Recent health policy efforts have sought to promote universal health coverage (UHC) as a means of providing affordable access to health services to populations. However, insurance schemes are heterogeneous, and some schemes may not provide necessary services to those covered. We explored the prevalence and determinants of ineffective insurance across 42 lower and middle income countries (LMICs) from the 2002-2004 World Health Survey.
Respondents were defined as having ineffective health insurance if they reported being insured and: were forced to borrow or sell personal items to pay for health services; had an untreated chronic condition; or had recently delivered a child outside of a skilled health facility (women only).
Among the insured, 13% had ineffective insurance, which was most commonly due to having to borrow or sell to pay for health care. The likelihood of ineffective insurance was lowest in upper-middle income countries and higher in other lower-middle and low-income countries. Ineffective insurance also decreased with family wealth and was higher among rural residents.
Our findings suggest that a high proportion of insurance in LMICs is ineffective, particularly among those who need it most, and that attention should be paid to effectiveness when defining health insurance in policy conversations about UHC.
最近的卫生政策努力旨在促进全民健康覆盖（UHC），作为为人群提供负担得起的卫生服务的一种手段。然而，保险计划存在异质性，并且一些计划可能无法为所涵盖的人群提供必要的服务。我们从 2002-2004 年世界卫生调查中探索了 42 个中低收入国家（LMIC）中无效保险的流行情况和决定因素。
如果受访者报告自己已参保并且：被迫借款或出售个人物品以支付医疗费用；患有未经治疗的慢性病；或最近在非熟练卫生机构（仅限妇女）分娩，那么他们被定义为拥有无效的健康保险。
在参保人群中，有 13%的人拥有无效保险，这主要是由于必须借款或出售物品来支付医疗费用。中上收入国家的无效保险的可能性最低，而其他中低收入和低收入国家的无效保险的可能性更高。无效保险也随着家庭财富的增加而减少，农村居民的无效保险的比例更高。
我们的研究结果表明，在 LMIC 中，相当比例的保险是无效的，特别是在那些最需要保险的人群中，在关于 UHC 的政策对话中定义健康保险时，应该关注其有效性。
