Strategies for Expanding Health Insurance Coverage for Vulnerable Populations: A Descriptive Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

YUAN Beibei ¹ , JIA Liying ¹ , WANG Jian ¹ , YU Baorong ¹ , GAO Jun ² , PAUL Garner ³ ,  MENG Qingyue ¹

1. Centre for Health Management and Policy, Shandong University, Jinan 250012, China;2. Center for Health Statistics and Information, Ministry of Health, Beijing 100044, China;3. Liverpool School of Tropical Medicine, Liverpool, UK;

Corresponding author：

MENG Qingyue, Email: qmeng@sdu.edu.cn

Keywords：

Health insurance; Coverage; Vulnerable populations; Systematic review

DOI：

10.7507/1672-2531.20080170

Video：

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Objectives　 To describe the range of strategies for expanding health insurance coverage for vulnerable population and how the authors have assessed these strategies.
Methods　 Search words were chosen by both health policy experts and search coordinators after discussion and pilot. What was searched included 28 electronic databases, 12 websites of health institutions, 3 grey literature databases and search engine Google. Any report of implemented strategies to expand health insurance coverage for vulnerable population was included. Pre-designed data extraction form was used for collecting strategies and study methods of the included studies. Then the extracted information was analyzed and described.
Results　 A total of 86 studies were included, most of which were the ones in the U.S. and the main targeted population was children. In terms of the study objective, 61 studies aimed to describe strategies and 25 ones are to evaluate effectiveness of the strategies. All strategies could be categorized into 6 groups based on the theoretical framework: changing eligibility criteria of health insurance, increasing awareness, making premium affordable, innovating enrollment approaches, improving health care delivery and strengthening management capacity. Most of the studies evaluating effectiveness were retrospective analysis of longitude data, and there were also two experimental studies.
Conclusions　 The U.S. and other developed countries have implemented a great many strategies for expanding insurance coverage, while few strategies and related studies are found in developing countries. However, developing countries can learn from the developed countries in extending health insurance coverage. The 25 included studies evaluating strategies need further systematic reviews to assess the effectiveness of these strategies.

Citation： YUAN Beibei,JIA Liying,WANG Jian,YU Baorong,GAO Jun,PAUL Garner,MENG Qingyue. Strategies for Expanding Health Insurance Coverage for Vulnerable Populations: A Descriptive Systematic Review. Chinese Journal of Evidence-Based Medicine, 2008, 08(9): 744-756. doi: 10.7507/1672-2531.20080170 Copy

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1. WHO. Sustainable health financing, universal coverage and socialhealth Insurance. Report, Ninth plenary meeting 2005, Eighthreport.
2. Hisao W. Design and implementation of Social Health Insurance. Report, World Bank Institute: WBI Development Studies 2007.
3. Carrin G, James C. Social Health insurance: key factors affecting the transition towards universal coverage. Internal Social Security Review, 2005, 58(1): 45-64.
4. Gilson L, Kalyalya D, Kuchler F, et al. The equity impacts of community financing activities in three African countries. Int J Health Plann Mgmt, 2002, 15(4): 291-317.
5. Habtom GK, Ruys P. Traditional risk-sharing arrangements and informal social insurance in Eritrea. Health Policy, 2007, 80(1):218-235.
6. Devadasan A, Ranson K, Dammea WV, et al. The landscape of community health insurance in India: An overview based on 10 case studies. Health Policy, 2006, 78(2-3): 224-234.
7. De Allegri M, Sanon M, Bridges J, et al. Understanding consumers’ preferences and decision to enroll in community-based health insurance in rural West Africa. Health Policy, 2006, 76(1): 58-71.
8. Arhin-Tenkorang D. Health Insurance for the informal sector in Africa: Design Features, Risk Protection, and Resource Mobilization. Paper, HNP, 2001.
9. DeNavas-Walt C, Proctor BD, Mills RJ. Income, Poverty, and Health Insurance Coverage in the United States: 2003 Report, U.S. Census Bureau, Washington D.C. 2004.
10. Mathauer I, Schmidt JO, Wenyaa M. Extending social health insurance to the informal sector in Kenya. An assessment of factors affecting demand. Int J Health Plann Mgmt, 2008, 23(1): 51-68.
11. Lagarde M. Evidence from systematic reviews to inform decisionmaking regarding financing mechanism that improve access to health services for poor people. Discussion paper, Alliance for Health Policy and Systematic Research, 2006.
12. Ekman B. Community-based health insurance in low-income countries: a systematic review of the evidence. Health Policy and Planning, 2004, 19 (5): 249-270.
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44. Gavin N. Evaluation of the BadgerCare Medicaid Demonstration. Report, Research Triangle Institute, 2003.
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46. Gordon JA, Dupuie TA. Child health insurance outreach through the emergency department: a pilot study. Academic Emergency Medicine, 2001, 8(11): 1088-1090.
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50. Holahan J, Coughl in T, Ku L, et al. Insuring the poor through section 1115 Medicaid waivers. Health Affairs, 1995, 14(1): 199-225.
51. Howell EM, Hughes D. A tale of two counties: expanding health insurance coverage for children in California. The Milbank Quarterly, 2006, 84(3): 521-554.
52. Kauffman JH. States use innovative children’s health insurance hotlines to enroll uninsured children. Issue brief, National Governors’ Association, February 22, 1999.
53. Kincheloe J, Frates J, Brown ER. Determinants of children’s participation in California’s Medicaid and SCHIP programs. Health Services Research, 2007, 42(2): 847-866.
54. Krebs-Carter M, Holahan J. State strategies for covering uninsured adults. Discussion paper, Urban Institute, 2000.
55. Kronebusch K, Elbel B. Simplifying children’s Medicaid and SCHIP. Health Affairs, 2004, 23(3): 233-246.
56. Lee HJ, Tian WH. The State Children’s Health Insurance Program: Participation and Substitution. Working Paper, Economic Research Initiative on the Uninsured, University of Michigan, 2004.
57. Leininger L. The impact of the Medicaid expansions of the late 1990’s on the insurance coverage of poor adolescents. Conference draft, Economic Research Initiative on the Uninsured, University, 2007.
58. Lo Sasso AT, Buchmueller TC. The effect of the state children’s health insurance program on health insurance coverage. Journal of Health Economics, 2004, 23(5): 1059-1082.
59. Long SK, Zuckerman S. MassHealth succeeds in expanding coverage for adults. Inquiry, 2004, 41(3): 268-279.
60. Lykens KA, Jargowsky PA. Medicaid matters: children’s health and medicaid el igibility expansions. Journal of Policy Analysis and Management, 2002, 21(2): 219-238.
61. Mahajan P, Stanley R, Ross KW, et al. Evaluation of an emergency department-based enrollment program for uninsured children. Annals of Emergency Medicine, 2005, 45(3): 245-250.
62. Mann C, Rowland D, Garfield R. Historical overview of children’s health care coverage. The Future of Children, 2003, 13(1): 31-53.
63. Marquis MS, Long SH. Uninsured children and national health reform. Journal of the American Medical Association, 1992, 268(24): 3473-3777.
64. Mathieson KM, Kronenfeld JJ. Barriers to enrollment and successful outreach strategies in chip: Reflections on the Arizona experience. Journal of Health Care for the Poor and Underserved, 2003, 14(4): 465-477.
65. Mauldon J, Nayeri K, Dobkin C. Welfare leavers’ use of Medicaid transitional medical assistance in California, 1993-1997. Inquiry, 2002, 39(4): 372-387.
66. Mitchell JB, Osber DS. Using Medicaid/SCHIP to insure working families: the Massachusetts experience. Health Care Finance Review, 2002, 23(3): 35-45.
67. Nakashian M. Covering Kids(R): A National Health Initiative for Low-Income Uninsured Children. Report, Robert Wood Johnson Foundation, 2005.
68. Norton SA. Medicaid coverage of maternity care for aliens in California. Family Planning Perspectives, 1996, 28(3): 108-112.
69. Rajan S. Publ icly subsidized health insurance: a typology of state approaches. Health Affairs, 1998, 17(3): 101-117.
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Chinese Journal of Evidence-Based Medicine

Strategies for Expanding Health Insurance Coverage for Vulnerable Populations: A Descriptive Systematic Review

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