The Impact of Health Insurance Schemes for the Informal Sector in Low- and Middle-Income Countries: A Systematic Review

被引:85
|
作者
Acharya, Arnab [1 ]
Vellakkal, Sukumar
Taylor, Fiona [2 ]
Masset, Edoardo
Satija, Ambika
Burke, Margaret [3 ]
Ebrahim, Shah [2 ]
机构
[1] London Sch Hyg & Trop Med, Dept Publ Hlth Policy, London, England
[2] London Sch Hyg & Trop Med, Dept Epidemiol & Populat Hlth, London, England
[3] Univ Bristol, Dept Social Med, Bristol BS8 1TH, Avon, England
来源
WORLD BANK RESEARCH OBSERVER | 2013年 / 28卷 / 02期
基金
英国经济与社会研究理事会; 美国国家科学基金会;
关键词
PROPENSITY SCORE; CARE SERVICES; POOR; EXPENDITURE; CONSUMPTION; ACCESS; INDIA; RISK;
D O I
10.1093/wbro/lks009
中图分类号
F0 [经济学]; F1 [世界各国经济概况、经济史、经济地理]; C [社会科学总论];
学科分类号
0201 ; 020105 ; 03 ; 0303 ;
摘要
This paper summarizes the literature on the impact of state subsidized or social health insurance schemes that have been offered, mostly on a voluntary basis, to the informal sector in low- and middle-income countries. A substantial number of papers provide estimations of average treatment on the treated effect for insured persons. We summarize papers that correct for the problem of self-selection into insurance and papers that estimate the average intention to treat effect. Summarizing the literature was difficult because of the lack of (1) uniformity in the use of meaningful definitions of outcomes that indicate welfare improvements and (2) clarity in the consideration of selection issues. We find the uptake of insurance schemes, in many cases, to be less than expected. In general, we find no strong evidence of an impact on utilization, protection from financial risk, and health status. However, a few insurance schemes afford significant protection from high levels of out-of-pocket expenditures. In these cases, however, the impact on the poor is weaker. More information is needed to understand the reasons for low enrollment and to explain the limited impact of health insurance among the insured.
引用
收藏
页码:236 / 266
页数:31
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