Evidence map›Paper›PMID 22984313›Full record

SynthesisBulletin of the World Health Organization2012

The impact of health insurance in Africa and Asia: a systematic review.

Ernst Spaan, Judith Mathijssen, Noor Tromp, Florence McBain, Arthur ten Have, Rob Baltussen

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Bulletin of the World Health Organization, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 144 papers, 18 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
144citing papers in PubMed, 18 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

144 citing papers in PubMed, 18 syntheses or guidelines pooled it.

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84 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Ernst SpaanDepartment of Primary and Community Care, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500HB Nijmegen, Netherlands. e.spaan@elg.umcn.nl
Judith Mathijssen
Noor Tromp
Florence McBain
Arthur ten Have
Rob Baltussen

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo evaluate the impact of health insurance on resource mobilization, financial protection, service utilization, quality of care, social inclusion and community empowerment in low- and lower-middle-income countries in Africa and Asia.

methodsA systematic search for randomized controlled trials, quasi-experimental and observational studies published before the end of 2011 was conducted in 20 literature databases, reference lists of relevant studies, web sites and the grey literature. Study quality was assessed with a quality grading protocol.

findingsInclusion criteria were met by 159 studies - 68 in Africa and 91 in Asia. Most African studies reported on community-based health insurance (CBHI) and were of relatively high quality; social health insurance (SHI) studies were mostly Asian and of medium quality. Only one Asian study dealt with private health insurance (PHI). Most studies were observational; four had randomized controls and 20 had a quasi-experimental design. Financial protection, utilization and social inclusion were far more common subjects than resource mobilization, quality of care or community empowerment. Strong evidence shows that CBHI and SHI improve service utilization and protect members financially by reducing their out-of-pocket expenditure, and that CBHI improves resource mobilization too. Weak evidence points to a positive effect of both SHI and CBHI on quality of care and social inclusion. The effect of SHI and CBHI on community empowerment is inconclusive. Findings for PHI are inconclusive in all domains because of insufficient studies.

conclusionHealth insurance offers some protection against the detrimental effects of user fees and a promising avenue towards universal health-care coverage.

Indexed as

Health Services AccessibilityHealth Status DisparitiesPower, PsychologicalSocial ClassAfricaAsiaHealth Services Needs and DemandHumansInsurance, HealthQuality of Health Care

Identifiers

PMID22984313
PMCPMC3442382

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.