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The impact of social, national and community-based health insurance on health care utilization for mental, neurological and substance-use disorders in low- and middle-income countries: a systematic review

Author

Listed:
  • Sumaiyah Docrat

    (University of Cape Town)

  • Donela Besada

    (Health Systems Research Unit, South Africa Medical Research Council)

  • Susan Cleary

    (University of Cape Town)

  • Crick Lund

    (University of Cape Town
    King’s College London)

Abstract

Background Whilst several systematic reviews conducted in Low- and Middle-Income Countries (LMICs) have revealed that coverage under social (SHI), national (NHI) and community-based (CBHI) health insurance has led to increased utilization of health care services, it remains unknown whether, and what aspects of, these shifts in financing result in improvements to mental health care utilization. The main aim of this review was to examine the impact of SHI, NHI and CBHI enrollment on mental health care utilization in LMICs. Methods Systematic searches were performed in nine databases of peer-reviewed journal articles: Pubmed, Scopus, SciELO via Web of Science, Africa Wide, CINAHL, PsychInfo, Academic Search Premier, Health Source Nursing Academic and EconLit for studies published before October 2018. The quality of the studies was assessed using the Effective Public Health Practice Project quality assessment tool for quantitative studies. The systematic review was reported according to the PRISMA guidelines (PROSPERO;2018; CRD42018111576). Results Eighteen studies were included in the review. Despite some heterogeneity across countries, the results demonstrated that enrollment in SHI, CBHI and NHI schemes increased utilization of mental health care. This was consistent for the length of inpatient admissions, number of hospitalizations, outpatient use of rehabilitation services, having ever received treatment for diagnosed schizophrenia and depression, compliance with drug therapies and the prescriptions of more favorable medications and therapies, when compared to the uninsured. The majority of included studies did not describe the insurance schemes and their organizational details at length, with limited discussion of the links between these features and the outcomes. Given the complexity of mental health service utilization in these diverse contexts, it was difficult to draw overall judgements on whether the impact of insurance enrollment was positive or negative for mental health care outcomes. Conclusions Studies that explore the impact of SHI, NHI and CBHI enrollment on mental health care utilization are limited both in number and scope. Despite the fact that many LMICs have been hailed for financing reforms towards universal health coverage, evidence on the positive impact of the reforms on mental health care utilization is only available for a small sub-set of these countries.

Suggested Citation

  • Sumaiyah Docrat & Donela Besada & Susan Cleary & Crick Lund, 2020. "The impact of social, national and community-based health insurance on health care utilization for mental, neurological and substance-use disorders in low- and middle-income countries: a systematic re," Health Economics Review, Springer, vol. 10(1), pages 1-23, December.
    • Handle: RePEc:spr:hecrev:v:10:y:2020:i:1:d:10.1186_s13561-020-00268-x
    DOI: 10.1186/s13561-020-00268-x
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    References listed on IDEAS

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    1. Shankar Prinja & Akashdeep Singh Chauhan & Anup Karan & Gunjeet Kaur & Rajesh Kumar, 2017. "Impact of Publicly Financed Health Insurance Schemes on Healthcare Utilization and Financial Risk Protection in India: A Systematic Review," PLOS ONE, Public Library of Science, vol. 12(2), pages 1-19, February.
    2. Koch, Kira Johanna & Cid Pedraza, Camilo & Schmid, Andreas, 2017. "Out-of-pocket expenditure and financial protection in the Chilean health care system—A systematic review," Health Policy, Elsevier, vol. 121(5), pages 481-494.
    3. Weiyan Jian & Yan Guo, 2009. "Does per‐diem reimbursement necessarily increase length of stay? The case of a public psychiatric hospital," Health Economics, John Wiley & Sons, Ltd., vol. 18(S2), pages 97-106, July.
    4. El-Sayed, Abdulrahman M. & Palma, Anton & Freedman, Lynn P. & Kruk, Margaret E., 2015. "Does health insurance mitigate inequities in non-communicable disease treatment? Evidence from 48 low- and middle-income countries," Health Policy, Elsevier, vol. 119(9), pages 1164-1175.
    5. Pablo Gottret & George J. Schieber & Hugh R. Waters, 2008. "Good Practices in Health Financing : Lessons from Reforms in Low and Middle-Income Countries," World Bank Publications - Books, The World Bank Group, number 6442.
    6. Crick Lund & Mark Tomlinson & Mary De Silva & Abebaw Fekadu & Rahul Shidhaye & Mark Jordans & Inge Petersen & Arvin Bhana & Fred Kigozi & Martin Prince & Graham Thornicroft & Charlotte Hanlon & Ritsuk, 2012. "PRIME: A Programme to Reduce the Treatment Gap for Mental Disorders in Five Low- and Middle-Income Countries," PLOS Medicine, Public Library of Science, vol. 9(12), pages 1-6, December.
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    1. Tuan, Truong Anh & Nam, Pham Khanh & Loan, Le Thanh, 2022. "The impact of health insurance on households’ financial choices: Evidence from Vietnam," Research in Economics, Elsevier, vol. 76(3), pages 264-276.

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