摘要
目的评价扩大儿童医疗保险覆盖率干预措施的效果。方法计算机检索e Cochrane Central Register of Controlled Trials(e Cochrane Library2009,Issue2)、PubMed(1951～2010)、EMbase(1966～2009)、PsycINFO(1967～2009)以及其它相关数据库和网站,同时检索纳入研究和相关综述的参考文献以及引用过纳入研究的文献。纳入随机对照试验、半随机对照试验、有对照组的前后对比研究、以及间断的时间序列研究。干预措施包括提高医疗保险知晓度、改进入保程序、提高保险机构的管理能力等。由两名研究者独立筛选文献、提取数据和评价纳入研究的偏倚并叙述性整合纳入研究结果。结果共纳入两个美国的研究,其中一个随机对照试验方法学上偏倚风险低,其评价的干预措施为社区医疗保险管理人员提供保险信息和申请协助,该措施有助于儿童加入医疗保险[RR=1.68,95%CI(1.44,1.96),n=257];另一个半随机对照研究发现在医院急诊部门发放保险资料对促进儿童加入医疗保险也有效[RR=1.50,95%CI(1.03,2.18),n=223],但该研究偏倚风险不详。结论社区医疗保险管理人员提供保险信息和申请协助以及在医院急诊部门发放医疗保险资料,有利于扩大儿童医疗保险覆盖率。但这些干预在美国之外其它国家的适用性还取决于医疗保险系统的背景。高质量相关文献的缺乏,提示需要开展更多不同国家和研究设计完善的评价医疗保险覆盖扩大策略的原始研究。
Objective To assess the effectiveness of outreach strategies for expanding insurance coverage of children who are eligible for health insurance schemes. Methods We searched The Cochrane Central Register of Controlled Trials （The Cochrane Library 2009, Issue 2）, PubMed （1951 to 2010）, EMBASE （1966 to 2009）, PsycINFO （1967 to 2009） and other relevant databases and websites. In addition, we searched the reference lists of included studies and relevant reviews, and carried out a citation search for included studies to nd more potentially relevant studies. Randomized controlled trials, controlled clinical trials, controlled before-after studies and interrupted time series which evaluated the effects of outreach strategies on increasing health insurance coverage for children. The included strategies were increasing awareness of schemes, modifying enrolment, improving management and organization of insurance schemes, and mixed strategies. Two review authors independently screened literatures, extracted data and assessed the risk of bias. We narra-tively summarized the data. Results We included two studies, both from the United States. One randomized controlled trial study with a low risk of bias showed that community-based case managers who provided health insurance informa-tion, application support were effective in enrolling Latino American children into health insurance schemes （RR=1.68, 95%CI 1.44 to 1.96, n=257）. The second quasi-randomized controlled trial, with an unclear risk of bias, indicated that handing out insurance application materials in hospital emergency departments can increase enrolment of children into health insurance （RR=1.50, 95% CI 1.03 to 2.18, n=223）. Conclusion The two studies included in this review provide evidence that providing health insurance information and application assistance and handing out application materials in hospital emergency departments can probably both improve insurance coverage of children. But the application of the interventions to other countries beyond the US still depends on contextual factors of health medical systems. Further studies evaluating the effectiveness of different outreach strategies for expanding health insurance coverage of children in different countries are needed, with careful attention given to study design.
出处
《中国循证医学杂志》
CSCD
2010年第10期1131-1137,共7页
Chinese Journal of Evidence-based Medicine
基金
世界卫生组织卫生政策与体系研究联盟的资金和技术支持~~
关键词
儿童
医疗保险
覆盖率
系统评价
Children
Health insurance
Coverage
Systematic review
