Azizatunnisa' Luthfi, Kuper Hannah, Banks Lena Morgon
International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK.
Department of Health Behaviour, Environment and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Int J Equity Health. 2024 Dec 18;23(1):264. doi: 10.1186/s12939-024-02339-5.
People with disabilities often incur higher costs for healthcare, due to higher needs, greater indirect costs, and the need for services not offered by the public system. Yet, people with disabilities are more likely to experience poverty and so have reduced capacity to pay. Health insurance is an important social protection strategy to meet healthcare needs and avoid catastrophic expenditures for this group. This systematic review synthesized evidence on health insurance coverage and potential effects among people with disabilities in low- and middle-income countries (LMICs).
This systematic review followed PRISMA Guidelines. We searched English peer-reviewed articles from nine databases (Medline, Embase, CINAHL, Web of Science, Scopus, Cochrane Library, PsyInfo, Global Health, and Econlit) from January 2000 to 24 January 2023. Two independent reviewers conducted the article selection, data extraction, and risk of bias assessment using NIH Guidelines. Studies were eligible for inclusion if they quantitatively assessed at least one of four key outcomes amongst people with disabilities: health insurance coverage/access, the association between health insurance and health care utilization, financial protection, or health status/outcome. Narrative synthesis was deployed due to high variety of outcome measurements.
Out of 8,545 records retrieved and three from hand search, 38 studies covering data from 51 countries met the eligibility criteria. Over two-thirds (68.4%) focused on access/coverage, which was generally limited amongst people with disabilities. Seventeen studies (44.7%) examined healthcare utilization, with a positive association (9/12) found between health insurance and the use of disability-related services. However, its association with general healthcare utilization (5 studies) remained inconclusive. Financial protection, explored by six studies (15.8%), similarly yielded inconclusive results. Only four studies (10.5%) reported on health status, and the findings suggest a favourable association of health insurance with self-reported health among people with disabilities (2/4), despite the limited number of high-quality studies.
There is considerable variability and limited evidence regarding health insurance coverage and its potential impact among individuals with disabilities in LMICs. This gap highlights the pressing need for further evaluations of health insurance, with a specific focus on people with disabilities, aligning with the broader goal of achieving Universal Health Coverage (UHC).
PROSPERO CRD42023389533.
由于需求更高、间接成本更大以及需要公共系统未提供的服务，残疾人的医疗保健费用往往更高。然而，残疾人更有可能陷入贫困，因此支付能力下降。医疗保险是满足这一群体医疗保健需求并避免灾难性支出的一项重要社会保护战略。本系统综述综合了关于低收入和中等收入国家（LMICs）残疾人医疗保险覆盖范围及其潜在影响的证据。
本系统综述遵循PRISMA指南。我们检索了2000年1月至2023年1月24日期间九个数据库（Medline、Embase、CINAHL、Web of Science、Scopus、Cochrane图书馆、PsyInfo、全球健康和Econlit）中的英文同行评审文章。两名独立评审员使用美国国立卫生研究院指南进行文章筛选、数据提取和偏倚风险评估。如果研究定量评估了残疾人的四个关键结果中的至少一个，则有资格纳入：医疗保险覆盖范围/可及性、医疗保险与医疗保健利用之间的关联、财务保护或健康状况/结果。由于结果测量种类繁多，采用了叙述性综合分析。
在检索到的8545条记录和通过手工检索得到的3条记录中，38项涵盖51个国家数据的研究符合纳入标准。超过三分之二（68.4%）的研究关注可及性/覆盖范围，而这在残疾人中通常有限。17项研究（44.7%）考察了医疗保健利用情况，发现医疗保险与残疾相关服务的使用之间存在正相关（9/12）。然而，其与一般医疗保健利用的关联（5项研究）仍无定论。六项研究（15.8%）探讨的财务保护也得出了不确定的结果。只有四项研究（10.5%）报告了健康状况，研究结果表明，尽管高质量研究数量有限，但医疗保险与残疾人自我报告的健康状况之间存在有利关联（2/4）。
关于低收入和中等收入国家残疾人的医疗保险覆盖范围及其潜在影响，存在相当大的差异且证据有限。这一差距凸显了迫切需要进一步评估医疗保险，特别关注残疾人，以符合实现全民健康覆盖（UHC）这一更广泛的目标。
PROSPERO CRD42023389533。
