Table 3 Association between health insurance and out-of-pocket payment, and catastrophic health expenditure
Studies | Country | Health insurance | Disability (measurement) | Outcome measure | Results (insured versus uninsured) | Association (insured vs uninsured) | Risk of bias |
|---|---|---|---|---|---|---|---|
Chen & Ning (2022) [96] | China | Long-term care insurance, Public | All types (Barthel Index – ADL function) | 1. OOP on outpatient 2. OOP on hospitalization 3. Total of OOP on outpatient and hospitalization | Coefficient (DiD & PSM) 1. 49.589 (P > 0.1) 2. -533.465 (P < 0.05) 3. -512.562 (P < 0.05) | Negative | Low |
Guan (2019) [97] | China | Any insurance, public | Vision impairment (clinical diagnosis, moderate VI or worse in both eyes; VA < 6/18) | Catastrophic health expenditure percentage among (30% threshold) | No insurance: 50% New Cooperative Medical Scheme: 47.9% Urban Resident Basic Medical Insurance (URBMI): 25% Urban Employee Basic Medical Insurance (UEBMI): 30.9% Government Medical Insurance: 16.7% Commercial Medical Insurance: 21.4% P: 0.008 | Positive | High |
Moradi (2021) [84] | Iran | Any health insurance | Physical, mental (Registry of the Rehabilitation Department of the Welfare Organization) | Catastrophic health expenditure (40% threshold) | Uninsured vs insured AOR 6.51 (95% CI: 3.69 – 8.24) | Negative | Low |
Palmer (2012) [74] | Vietnam | Compulsory Health Insurance, Public | All types (self-reported yes/no: mobility, hearing, speaking, learning, mental, vision – only severe included) | Expenditure on: 1. Public inpatient (12 months) 2. Public outpatient (1 month) Insured people with disabilities vs uninsured people with disabilities | 1. Coefficient -0.067 P:0.1 2. Coefficient 0.013 P > 0.1 | Null | Medium |
Palmer (2012) [74] | Vietnam | Compulsory Health Insurance, Public | All types (self-reported yes/no: mobility, hearing, speaking, learning, mental, vision) | Expenditure on: 1. Public inpatient (12 months) 2. Public outpatient (1 month) Insured people with disabilities vs insured people without disability | 1. 1297.919 vs 783.881 (P < 0.05) 2. 23.725 vs 17.230 (P > 0.05) | Positive | Medium |
Palmer (2014) [88] | Vietnam | Social health insurance, Public | All types (Washington Group Short Set) | 1. Inpatient expenditure per visit 2. Outpatient expenditure per visit 3. Self-treatment per visit 4. CHE 10% 5. CHE 20% 6. CHE 40% 7. Poverty 8. Poverty net of health payment 9. Poverty differential | PSM 1. 103.062 (P > 0.1) 2. -20.351 (P > 0.1) 3. 2.088 (P > 0.1) 4. -0.052 (P > 0.1) 5. -0.090 (P < 0.1) 6. -0.017 (P > 0.1) 7. 0.009 (P > 0.1) 8. 0.021 (P > 0.1) 9. 0.012 (P > 0.1) Covariate matching 1. 213.435 (P < 0.05) 2. 3.904 (P > 0.1) 3. 1.111 (P > 0.1) 4. -0.073 (P < 0.01) 5. -0.066 (P < 0.01) 6. 0.015 (P > 0.1) 7. 0.042 (P < 0.05) 8. 0.081 (P < 0.05) 9. 0.039 (P < 0.01) | OOP (1–3): Positive CHE 10%: Negative CHE 20%: Negative CHE 40%: null Poverty (7–9): Positive | Low |
Zhang (2018) [95] | China | Urban Employee Basic Medical Insurance (UEBMI), Public | Mental – schizophrenia (clinical diagnosis based on ICD-10, F20) | OOP payment at: 1. baseline 2. 1 year follow up 3. 2 years follow up 4. 3 years follow up | UEBMI (more generous) vs URBMI 1. 12.7% vs 13.5% P: 0.021 2. 10.7% vs 14.5% P < 0.001 3. 10.7% vs 5.9% P < 0.001 4. 9.5% vs 6.1% P < 0.001 | Mixed 1. Negative 2. Negative 3. Positive 4. Positive | Low |