The Effect of Health Insurance on the Utilization of Health Services: A Systematic Review and Meta-Analysis
DOI:
https://doi.org/10.31661/gmj.v8i.1411Keywords:
Health Care Utilization, Health Insurance, Inpatient, Outpatient CareAbstract
Insurance organizations are among the most influential organizations in the health system, which can lead to healthcare efficiency and patient satisfaction in case they are increasingly accessed. The main purpose of the present systematic review was to examine the effect of health insurance on the utilization of health services and also to examine the factors affecting it. The present study was a systematic review that aimed to examine the effect of health insurance on the utilization of health care services. The study was conducted in 2016 using Scopus, PubMed, Web of Science, Science Direct, and ProQuest databases. We examined the utilization rate of health insurance in insured people. The inclusion and exclusion criteria were included based on review and meta-analysis purposes. The utilization of health services increased for inpatient and outpatient services. The utilization rate of inpatient services increased by 0.51% whereas the utilization rate of outpatient services increased by 1.26%. We classified the variables affecting the utilization rate of insurance into three main categories and sub-categories: demographic variables of the household, socioeconomic status, and health status. Our study showed that insured people increased the utilization rate of health services, depending on the type of health services. Thus, health policymakers should consider the community’s health insurance as a priority for health programs. For now, implementing universal health insurance is a good solution. [GMJ.2019;8:e1411]
References
Lang T, Davido A, Diakite B, Agay E, Viel JF, Flicoteaux B. Using the hospital emergency department as a regular source of care. Eur J Epidemiol. 1997; 13(2):223-8. https://doi.org/10.1023/A:1007372800998PMid:9085009 Mohammadpur A, Motallebi M, Khjavi AM, Bazeli J. The quality of receving medical services in the socity by people and the factors that impact on it. ofogh-e-danesh. 2003; 8(2). Khayatan M. Assessing the effective factors on person's access to health care services in Urban Health Care Centers by their staff's viewpoint in 2008. TUMS 2008; Faculty of Allied Medical Sciences. [Thesis in Persian] Gertler P, Sturm R. Private health insurance and public expenditures in Jamaica. Journal of econometrics. 1997; 77(1):237-57. https://doi.org/10.1016/S0304-4076(96)01814-3 Miles S, Parker K. Men, Women, and Health Insurance. N Engl J Med. 1997; 336(3):218-21. https://doi.org/10.1056/NEJM199701163360312PMid:8988905 Philip NE, Kannan S, Sarma S. Utilization of comprehensive health insurance scheme, Kerala: a comparative study of insured and uninsured below-poverty-line households. Asia Pac J Public Health. 2016; 28(1_suppl):77S-85S. https://doi.org/10.1177/1010539515602306PMid:26316502 Cassedy A, Fairbrother G, Newacheck P. The impact of insurance instability on children's access, utilization and satisfaction with health care. Ambulatory Pediatrics. 2008; 8(5):321-8. https://doi.org/10.1016/j.ambp.2008.04.007PMid:18922506 Hahn B. Health care utilization: the effect of extending insurance to adults on Medicaid or uninsured. Medical Care. JSTOR. 1994 :227-39. https://doi.org/10.1097/00005650-199403000-00004PMid:8145600 Hwang S, Ueng J, Chiu S, Kiss A, Tolomiczenko G, Cowan L, et al. Universal health insurance and health care access for homeless persons. Am J Public Health. 2010; 100(8):1454-61. https://doi.org/10.2105/AJPH.2009.182022PMid:20558789 PMCid:PMC2901287 Shou-Hsia C, Tung-Liang C. The effect of universal health insurance on health care utilization in Taiwan: results from a natural experiment. Jama. 1997; 278(2):89-93. https://doi.org/10.1001/jama.1997.03550020017009 Neena E, Philip M, Srinivasan K. Utilization of Comprehensive Health Insurance Scheme, Kerala: A Comparative Study of Insured and Uninsured Below-Poverty-Line Households. J Public Health. 2015; 1-9. https://doi.org/10.1177/1010539515602306PMid:26316502 Stephen W. Hwang M, Catharine Chambers, Shirley Chiu, Marko Katic, Alex Kiss, Donald A. Redelmeier, and Wendy Levinson. A Comprehensive Assessment of Health Care Utilization Among Homeless Adults Under a System ofUniversal Health Insurance. Am J Public Health. 2013; 103. https://doi.org/10.2105/AJPH.2013.301369PMid:24148051 PMCid:PMC3969141 Bourne P. Self-reported health and medical care-seeking behaviour of uninsured Jamaicans. North AJMS. 2010; 2(2):71. Jeon B, Kwon S. Effect of private health insurance on health care utilization in a universal public insurance system: a case of South Korea. Health policy. Elsevier. 2013; 113(1-2):69-76. https://doi.org/10.1016/j.healthpol.2013.05.007PMid:23786992 Carter T, Adams M, Judd A, Leeper J, Wang L, Yu J. Children's health insurance status, access to and utilization of health services, and unmet health needs in a rural Alabama school system. J Rural Health. 2003; 19(4):511-3. https://doi.org/10.1111/j.1748-0361.2003.tb00590.xPMid:14526511 Hamilton E, Hummer R, You X, Padilla Y. Health Insurance and Health-Care Utilization of US-Born Mexican-American Children. Social Science Quarterly. 2006; 87(5):1280-94. https://doi.org/10.1111/j.1540-6237.2006.00428.x Hwang S, Chambers C, Chiu S, Katic M, Kiss A, Redelmeier D, et al. A comprehensive assessment of health care utilization among homeless adults under a system of universal health insurance. Am J Public Health. 2013; 103(S2):S294-S301. https://doi.org/10.2105/AJPH.2013.301369PMid:24148051 PMCid:PMC3969141 Shin H, Song H, Kim J, Probst J. Insurance, acculturation, and health service utilization among Korean-Americans. J Immigr Health. 2005; 7(2):65-74. https://doi.org/10.1007/s10903-005-2638-4PMid:15789158 Kushel M, Gupta R, Gee L, Haas J. Housing instability and food insecurity as barriers to health care among low-income Americans. J Gen Intern Med. 2006; 21(1):71-7. https://doi.org/10.1111/j.1525-1497.2005.00278.xPMid:16423128 PMCid:PMC1484604 Weinreb L, Perloff J, Goldberg R, Lessard D, Hosmer D. Factors associated with health service utilization patterns in low-income women. J Health Care Poor Underserved. 2006; 17(1):180-99. https://doi.org/10.1353/hpu.2006.0036PMid:16520526 D'Amore J, Hung O, Chiang W, Goldfrank L. The epidemiology of the homeless population and its impact on an urban emergency department. Acad Emerg Med. 2001; 8(11):1051-5. https://doi.org/10.1111/j.1553-2712.2001.tb01114.xPMid:11691667 Mandelberg J, Kuhn R, Kohn M. Epidemiologic analysis of an urban, public emergency department's frequent users. Acad Emerg Med. 2000; 7(6):637-46. https://doi.org/10.1111/j.1553-2712.2000.tb02037.xPMid:10905642 Kondo A, Shigeoka H. Effects of universal health insurance on health care utilization, and supply-side responses: evidence from Japan. J Public Econ. 2013; 99:1-23. https://doi.org/10.1016/j.jpubeco.2012.12.004 Salit S, Kuhn E, Hartz A, Vu J, Mosso A. Hospitalization costs associated with homelessness in New York City. N Engl J Med. 1998; 338(24):1734-40. https://doi.org/10.1056/NEJM199806113382406PMid:9624194 Andersen R, Newman J. Societal and individual determinants of medical care utilization in the United States. Milbank Q 2005; 83(4):Online-only-Online-only. https://doi.org/10.1111/j.1468-0009.2005.00428.xPMCid:PMC2690261 Card D, Dobkin C, Maestas N. The Impact of Nearly Universal Insurance Coverage on Health Care Utilization: Evidence from Medicare. Am Econ Rev. 2008; 98(5):2242-58. https://doi.org/10.1257/aer.98.5.2242PMid:19079738 PMCid:PMC2600774 Saliba B, Ventelou B. Complementary health insurance in France. Who pays? Why? Who will suffer from public disengagement? Health Policy. 2007; 81(2-3):166-82. https://doi.org/10.1016/j.healthpol.2006.05.017PMid:16831483 Buchmueller T, Fiebig D, Jones G, Savage E. Preference heterogeneity and selection in private health insurance: the case of Australia. J Health Econ. 2013; 32(5):757-67. https://doi.org/10.1016/j.jhealeco.2013.05.001PMid:23770762 Hullegie P, Klein T. The effect of private health insurance on medical care utilization and self-assessed health in Germany. Health economics. 2010; 19(9):1048-62. https://doi.org/10.1002/hec.1642PMid:20665706 Kiil A. What characterises the privately insured in universal health care systems? A review of the empirical evidence. Health Policy. 2012; 106(1):60-75. https://doi.org/10.1016/j.healthpol.2012.02.019PMid:22459052 Riphahn R, Wambach A, Million A. Incentive effects in the demand for health care: a bivariate panel count data estimation. J Appl Econ (Chichester Engl). 2003;18(4):387-405. https://doi.org/10.1002/jae.680 Zandi S. The Survey of Distribution, Causes and Costs of Hospitalization of Old Patients Supported by Medical Services Insurance Organization in Sanandaj Besat Hospital,[MPH Dissertation]. TUMSc 2008; 1387. Gulliford M, Morgan M. Access to health care. Routledge; 2013. https://doi.org/10.4324/9780203867952 Hanratty B, Zhang T, Whitehead M. How close have universal health systems come to achieving equity in use of curative services? A systematic review. Int J Health Serv. 2007; 37(1):89-109. https://doi.org/10.2190/TTX2-3572-UL81-62W7PMid:17436987 Shou-Hsia C. The effect of universal health insurance on health care utilization in Taiwan. Jama 1997; Jul. 09;278(2):89-93. https://doi.org/10.1001/jama.278.2.89PMid:9214512 Jeon B. Effect of private health insurance on health care utilization in a universal public insurance system. A case of South Korea Health Policy. 2013 Nov;113(1-2):69-76. https://doi.org/10.1016/j.healthpol.2013.05.007PMid:23786992 Cassedy A, Newacheck PW. The Impact of Insurance Instability on Children's Access, Utilization, and Satisfaction with Health Care. Ambulatory Pediatrics. 2008;8(5):321-8. https://doi.org/10.1016/j.ambp.2008.04.007PMid:18922506 Tracy M, Carter M, Alesa H, James D, Lei W. Children's Health Insurance Status, Access to and Utilization of Health Services, and Unmet Health Needs in a Rural Alabama School System. J Rural Health. 2003. https://doi.org/10.1111/j.1748-0361.2003.tb00590.xPMid:14526511
![](https://journals.salviapub.com/public/journals/1/submission_1411_1411_coverImage_en_US.jpg)