社区医疗保险对埃塞俄比亚医疗服务利用的影响：系统评价和荟萃分析。

Effect of community based health insurance on healthcare services utilization in Ethiopia: a systematic review and meta-analysis.

机构信息

Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.

Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.

出版信息

BMC Health Serv Res. 2024 Oct 5;24(1):1188. doi: 10.1186/s12913-024-11617-5.

DOI:10.1186/s12913-024-11617-5

PMID:39369193

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11456236/

Abstract

BACKGROUND

Community based health insurance (CBHI) is characterized by voluntary involvement, pooling of health risks and of funds occur within a community. It is becoming increasingly popular way to increase the use of healthcare services in low- and middle-income nations. Understanding the effect of CBHI on the level of health services utilization is a paramount for evidence based decision making. Hence, this study aimed to estimate the pooled effect of CBHI on health services utilization in Ethiopia.

METHODS

Studies were searched from PubMed, Google scholar, Web of Science, Research4life, Science Direct, African Journal Online and national websites for grey literatures. We were adhered to the PRISMA guidelines. Cross sectional and quasi experimental studies were included. Studies were screened, and critically appraised for quality using Joanna Briggs Institute Critical Appraisal tools. The data were extracted using Microsoft excel and exported to STATA 17 and RevMan 5.4.1 for further analysis. Heterogeneity between studies was assessed using Cochran's Q statistic and quantified with I. A random-effects model was used to estimate the pooled effect size. Subgroup analysis was done to show variations of the effect sizes across study years.

RESULT

A total of 1501 studies were identified, out of which only 14 of them were included in the final meta-analysis. Health services utilization among CBHI members and non-members was 69.1% [95%CI (57.1-81.1%)] versus 50.9% [95%CI (40.6-61.3%)] respectively (difference in the effect was 18.2%). The CBHI members were nearly three folds more likely to utilize health services as compared with their counterparts [OR = 2.54, 95%CI: (1.81, 3.57). On average, CBHI users had 1.14 increased health facility visits as compared to non-insured, mean difference (MD) = 1.14 visits with 95% CI (0.65-1.63).

CONCLUSION

The CBHI has a significantly increased health service utilization in Ethiopia. Hence, it will have a great contribution to meet the health for all agenda in resource limited countries.

摘要

背景

社区健康保险（CBHI）的特点是自愿参与、在社区内汇集健康风险和资金。它正在成为增加中低收入国家医疗服务使用的一种日益流行的方式。了解 CBHI 对卫生服务利用水平的影响对于基于证据的决策至关重要。因此，本研究旨在估计 CBHI 对埃塞俄比亚卫生服务利用的综合影响。

方法

从 PubMed、Google Scholar、Web of Science、Research4life、Science Direct、African Journal Online 和国家灰色文献网站搜索研究。我们遵循 PRISMA 指南。纳入横断面和准实验研究。使用 Joanna Briggs Institute 批判性评价工具筛选和批判性评价研究质量。使用 Microsoft excel 提取数据，并将其导出到 STATA 17 和 RevMan 5.4.1 进行进一步分析。使用 Cochran's Q 统计量评估研究之间的异质性，并使用 I 量化。使用随机效应模型估计汇总效应大小。进行亚组分析以显示研究年份之间效应大小的变化。

结果

共确定了 1501 项研究，其中只有 14 项研究纳入最终的荟萃分析。CBHI 成员和非成员的卫生服务利用率分别为 69.1%[95%CI（57.1-81.1%）]和 50.9%[95%CI（40.6-61.3%）]（效果差异为 18.2%）。与对照组相比，CBHI 成员利用卫生服务的可能性几乎高出三倍[OR=2.54，95%CI：（1.81,3.57）]。平均而言，CBHI 用户比未参保者增加了 1.14 次就诊，平均差值（MD）=1.14 次就诊，95%CI（0.65-1.63）。