Cover Image

The Effect of Health Insurance on the Utilization of Health Services: A Systematic Review and Meta-Analysis

Elham Shami, Jafar Sadegh Tabrizi, Shirin Nosratnejad

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]

Health Care Utilization; Health Insurance; Inpatient; Outpatient Care

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:1007372800998

PMid: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/NEJM199701163360312

PMid: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/10.1177/1010539515602306

PMid: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.2008.04.007

PMid: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/10.1097/00005650-199403000-00004

PMid: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.2009.182022

PMid: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/10.1177/1010539515602306

PMid: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.2013.301369

PMid: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.2013.05.007

PMid: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.x

PMid: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.2013.301369

PMid: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/s10903-005-2638-4

PMid: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.x

PMid: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.2006.0036

PMid: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.x

PMid: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.x

PMid: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/NEJM199806113382406

PMid: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.x

PMCid: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.98.5.2242

PMid: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.2006.05.017

PMid: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.2013.05.001

PMid: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.1642

PMid: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.2012.02.019

PMid: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-UL81-62W7

PMid: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.278.2.89

PMid: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.2013.05.007

PMid: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.2008.04.007

PMid: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.x

PMid:14526511

Refbacks

  • There are currently no refbacks.