兒童醫療保險覆蓋率擴大策略的系統評價_《中國循證醫學雜志》

作者：

袁蓓蓓 , 賈莉英 ¹ , 王健 ¹ ,  孟慶躍 ¹ , Paul Garner ¹

1. 山東大學衛生管理與政策研究中心；衛生部衛生經濟與政策研究重點實驗室（濟南 250012）；2. Liverpool School of Tropical Medicine，Liverpool，UK;

關鍵詞：

兒童醫療保險覆蓋率系統評價

DOI：

10.7507/1672-2531.20100558

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摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　評價擴大兒童醫療保險覆蓋率干預措施的效果。
方法　計算機檢索The Cochrane Central Register of Controlled Trials（The Cochrane Library 2009，Issue 2）、PubMed（1951～2010）、EMbase（1966～2009）、PsycINFO（1967～2009）以及其它相關數據庫和網站，同時檢索納入研究和相關綜述的參考文獻以及引用過納入研究的文獻。納入隨機對照試驗、半隨機對照試驗、有對照組的前后對比研究、以及間斷的時間序列研究。干預措施包括提高醫療保險知曉度、改進入保程序、提高保險機構的管理能力等。由兩名研究者獨立篩選文獻、提取數據和評價納入研究的偏倚并敘述性整合納入研究結果。
結果　共納入兩個美國的研究，其中一個隨機對照試驗方法學上偏倚風險低，其評價的干預措施為社區醫療保險管理人員提供保險信息和申請協助，該措施有助于兒童加入醫療保險［RR=1.68，95%CI（1.44，1.96），n=257］；另一個半隨機對照研究發現在醫院急診部門發放保險資料對促進兒童加入醫療保險也有效［RR=1.50，95%CI（1.03，2.18），n=223］，但該研究偏倚風險不詳。
結論　社區醫療保險管理人員提供保險信息和申請協助以及在醫院急診部門發放醫療保險資料，有利于擴大兒童醫療保險覆蓋率。但這些干預在美國之外其它國家的適用性還取決于醫療保險系統的背景。高質量相關文獻的缺乏，提示需要開展更多不同國家和研究設計完善的評價醫療保險覆蓋擴大策略的原始研究。

引用本文： 袁蓓蓓,賈莉英,王健,孟慶躍,Paul Garner. 兒童醫療保險覆蓋率擴大策略的系統評價. 中國循證醫學雜志, 2010, 10(10): 1131-1137. doi: 10.7507/1672-2531.20100558 復制

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8.	Jacobson M, Buchmueller TC. Can private companies contribute to public programs’outreach efforts? Evidence from California. Health Affairs, 2007, 26(2): 538-548.
9.	Langwell K, Laschober M, Cox D, et al. American Indian and Alaska Native eligibility and enrollment in Medicaid, SCHIP and Medicare. Centers for Medicare & Medicaid Services, 2003 December.
10.	Haley J, Kenney G. Low-income uninsured children with special health care needs: why aren’t they enrolled in public health insurance programs? Pediatrics, 2007, 119: 60-68.
11.	Andrulis DP, Bauer TA, Hopkins S. Strategies to increase enrollment in children’s health insurance programs: A guide to outreach, marketing and enrollment in New York and other states. A report of the New York Academy of Medicine. Journal of Urban Health, 1999, 76: 247-279.
12.	Buchmueller TC, Jacobson M. Can private companies contribute to public outreach efforts? Evidence from California. Health Affairs, 2007, 26: 538-548.
13.	Carrin G. Community Based Health Insurance Schemes in developing countries: facts, problems and perspectives. World Health Organization, 2003.
14.	Zambrana RE, Carter-Pokras O. Improving health insurance coverage for Latino children: a review of barriers, challenges and State strategies. Journal of the National Medical Association, 2004, 96: 508-523.
15.	The GRADE working group. Grading quality of evidence and strength of recommendations. BMJ, 2004, 328: 1490-1494.
16.	Flores G, Abreu M, Chaisson CE, et al. A randomized, controlled trial of the effectiveness of community-based case management in insuring uninsured Latino children. Pediatrics, 2005, 116: 1433-1441.
17.	Gordon JA, Emond JA, Camargo CA. The State Children’s Health Insurance Program: a multicenter trial of outreach through the emergency department. American Journal of Public Health, 2005, 95(2): 250-253.
18.	Aizer A. Covering Kids: efforts to increase the health insurance coverage of poor children. University of California, Los Angeles, 2002.
19.	Aizer A. Public health insurance, program take-up, and child health. Working paper, National Bureau of Economic Research, 2006.
20.	Bansak C, Raphael S. The effects of state policy design features on take-up and crowd-out rates for the State Children’s Health Insurance Program. Journal of Policy Analysis and Management, 2006, 26(1): 149-175.
21.	Brown AM, Glazer G. Enrollment success in state children’s health insurance program after free clinic referral. Journal of Pediatric Health Care, 2004, 18(3): 145-148.
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24.	Cousineau MR, Wada EO, Hogan L. Enrolling in Medicaid through the National School Lunch Program: outcome of a pilot project in California schools. Public Health Reports, 2007, 122(4): 452-460.
25.	Dutton M, Katz S, Pennington A. Using community groups and student volunteers to enroll uninsured children in Medicaid and children health plus. The Commonwealth Fund, 2000.
26.	Gordon JA, Dupuie TA. Child health insurance outreach through the emergency department: a pilot study. Academic Emergency Medicine, 2001, 8(11): 1088-1090.
27.	Hill I, Dubay L, Kenney GM, et al. Improving coverage and access for immigrant Latino children: the Los Angeles healthy kids program. Health Affair, 2008, 27(2): 550-559.
28.	Kincheloe JR. The determinants of participation in California’s Medi-Cal and Healthy Families Programs by eligible children. United States, California, University of California, Los Angeles, 2004.
29.	Lee HJ, Tian WH. The State Children’s Health Insurance Program: participation and substitution. The Social Science Journal, 2008, 45(3): 382-400.
30.	Lichtenstein B, Sharma AK, Wheat JR. Health inequity: the plight of uninsured children in a rural Alabama county and the plan to cure it. Family and Community Health, 2005, 28(2): 156-167.
31.	Mahajan P, Stanley R, Ross KW, et al. Evaluation of an emergency department-based enrollment program for uninsured children. Annals of Emergency Medicine, 2005, 45(3): 245-250.
32.	Meyer CL, Brun C, Yung B, et al. Evaluation of social marketing efforts designed to increase enrollment in the Children’s Health Insurance Program (CHIP). Journal of Nonprofit & Public Sector Marketing, 2004, 12(2): 87-104.
33.	Ray J, White M, Cannon P, et al. Implementing the Florida KidCare open enrollment communications campaign: a framework for mobilizing community partners to reduce the number of uninsured children. International Quarterly of Community Health Education, 2006, 26(4): 365-377.
34.	Sieben I, Rosenberg TJ, Bazile Y. The Role of WIC Center and Small Businesses in Enrolling Uninsured Children in Medicaid and Child Health Plus. Medical and Health Research Association of New York City, Inc. 2000.
35.	Wada EO, Cousineau MR. Assessing community-based outreach and enrollment activities and outcomes relative to need in Los Angeles County. The Center for Community Health Studies, USC Keck School of Medicine, Department of Family Medicine, 2006.
36.	Wolfe B, Scrivner S. The devil may be in the details: how the characteristics of SCHIP programs affect take-up. Journal of Policy Analysis and Management, 2005, 24(3): 499-522.
37.	Ziegenfuss JK. Encouraging eligible children’s participation in public health insurance: the role of national awareness campaigns. United States, Minnesota, University of Minnesota, 2008.
38.	Carpenter BM, Kavanagh L. Outreach to children: moving from enrollment to ensuring access. Bright Futures in Managed Care Project at the National Institute for Health Care Management, the Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services, 1998.

1. Kuehl KS, Baffa JM, Chase GA. Insurance and education determine survival in infantile coarctation of the aorta. Journal of Health Care for the Poor and Underserved, 2000, 11: 400-411.
2. Zhang X, Wang L, Zhu X, et al. Knowledge, attitude and practice survey on immunization service delivery in Guangxi and Gansu, China. Social Science & Medicine, 1999, 49: 1125-1127.
3. Hisao W. Design and implementation of Social Health Insurance. World Bank Institute: WBI Development Studies, 2007.
4. Carrin G, James C. Social Health insurance: key factors affecting the transition towards universal coverage. Internal Social Security Review, 2005, 58(1): 45-64.
5. DeNavas-Walt C, Proctor BD, Lee CH. Income, poverty, and health insurance coverage in the United States: 2005. Washington, DC: US Government Printing Office, 2005.
6. Lu M, Zhang J, Ma J, et al. Child health insurance coverage: a survey among temporary and permanent residents in Shanghai. BMC Health Services Research, 2008, 8: 238.
7. 袁蓓蓓, 賈莉英, 王健, 等. 擴大脆弱人群健康保險覆蓋率的策略: 描述性系統評價. 中國循證醫學雜志, 2008, 8(9): 744-756.
8. Jacobson M, Buchmueller TC. Can private companies contribute to public programs’outreach efforts? Evidence from California. Health Affairs, 2007, 26(2): 538-548.
9. Langwell K, Laschober M, Cox D, et al. American Indian and Alaska Native eligibility and enrollment in Medicaid, SCHIP and Medicare. Centers for Medicare & Medicaid Services, 2003 December.
10. Haley J, Kenney G. Low-income uninsured children with special health care needs: why aren’t they enrolled in public health insurance programs? Pediatrics, 2007, 119: 60-68.
11. Andrulis DP, Bauer TA, Hopkins S. Strategies to increase enrollment in children’s health insurance programs: A guide to outreach, marketing and enrollment in New York and other states. A report of the New York Academy of Medicine. Journal of Urban Health, 1999, 76: 247-279.
12. Buchmueller TC, Jacobson M. Can private companies contribute to public outreach efforts? Evidence from California. Health Affairs, 2007, 26: 538-548.
13. Carrin G. Community Based Health Insurance Schemes in developing countries: facts, problems and perspectives. World Health Organization, 2003.
14. Zambrana RE, Carter-Pokras O. Improving health insurance coverage for Latino children: a review of barriers, challenges and State strategies. Journal of the National Medical Association, 2004, 96: 508-523.
15. The GRADE working group. Grading quality of evidence and strength of recommendations. BMJ, 2004, 328: 1490-1494.
16. Flores G, Abreu M, Chaisson CE, et al. A randomized, controlled trial of the effectiveness of community-based case management in insuring uninsured Latino children. Pediatrics, 2005, 116: 1433-1441.
17. Gordon JA, Emond JA, Camargo CA. The State Children’s Health Insurance Program: a multicenter trial of outreach through the emergency department. American Journal of Public Health, 2005, 95(2): 250-253.
18. Aizer A. Covering Kids: efforts to increase the health insurance coverage of poor children. University of California, Los Angeles, 2002.
19. Aizer A. Public health insurance, program take-up, and child health. Working paper, National Bureau of Economic Research, 2006.
20. Bansak C, Raphael S. The effects of state policy design features on take-up and crowd-out rates for the State Children’s Health Insurance Program. Journal of Policy Analysis and Management, 2006, 26(1): 149-175.
21. Brown AM, Glazer G. Enrollment success in state children’s health insurance program after free clinic referral. Journal of Pediatric Health Care, 2004, 18(3): 145-148.
22. Carter TM. Alabama rural partnerships: addressing the health needs of school children. United States, Alabama, The University of Alabama, 2006.
23. Chen JY, Swonger S, Kominski G, et al. Cost-effectiveness of insuring the uninsured: the case of Korean American children. Medical Decision Making, 2009, 29: 51-60.
24. Cousineau MR, Wada EO, Hogan L. Enrolling in Medicaid through the National School Lunch Program: outcome of a pilot project in California schools. Public Health Reports, 2007, 122(4): 452-460.
25. Dutton M, Katz S, Pennington A. Using community groups and student volunteers to enroll uninsured children in Medicaid and children health plus. The Commonwealth Fund, 2000.
26. Gordon JA, Dupuie TA. Child health insurance outreach through the emergency department: a pilot study. Academic Emergency Medicine, 2001, 8(11): 1088-1090.
27. Hill I, Dubay L, Kenney GM, et al. Improving coverage and access for immigrant Latino children: the Los Angeles healthy kids program. Health Affair, 2008, 27(2): 550-559.
28. Kincheloe JR. The determinants of participation in California’s Medi-Cal and Healthy Families Programs by eligible children. United States, California, University of California, Los Angeles, 2004.
29. Lee HJ, Tian WH. The State Children’s Health Insurance Program: participation and substitution. The Social Science Journal, 2008, 45(3): 382-400.
30. Lichtenstein B, Sharma AK, Wheat JR. Health inequity: the plight of uninsured children in a rural Alabama county and the plan to cure it. Family and Community Health, 2005, 28(2): 156-167.
31. Mahajan P, Stanley R, Ross KW, et al. Evaluation of an emergency department-based enrollment program for uninsured children. Annals of Emergency Medicine, 2005, 45(3): 245-250.
32. Meyer CL, Brun C, Yung B, et al. Evaluation of social marketing efforts designed to increase enrollment in the Children’s Health Insurance Program (CHIP). Journal of Nonprofit & Public Sector Marketing, 2004, 12(2): 87-104.
33. Ray J, White M, Cannon P, et al. Implementing the Florida KidCare open enrollment communications campaign: a framework for mobilizing community partners to reduce the number of uninsured children. International Quarterly of Community Health Education, 2006, 26(4): 365-377.
34. Sieben I, Rosenberg TJ, Bazile Y. The Role of WIC Center and Small Businesses in Enrolling Uninsured Children in Medicaid and Child Health Plus. Medical and Health Research Association of New York City, Inc. 2000.
35. Wada EO, Cousineau MR. Assessing community-based outreach and enrollment activities and outcomes relative to need in Los Angeles County. The Center for Community Health Studies, USC Keck School of Medicine, Department of Family Medicine, 2006.
36. Wolfe B, Scrivner S. The devil may be in the details: how the characteristics of SCHIP programs affect take-up. Journal of Policy Analysis and Management, 2005, 24(3): 499-522.
37. Ziegenfuss JK. Encouraging eligible children’s participation in public health insurance: the role of national awareness campaigns. United States, Minnesota, University of Minnesota, 2008.
38. Carpenter BM, Kavanagh L. Outreach to children: moving from enrollment to ensuring access. Bright Futures in Managed Care Project at the National Institute for Health Care Management, the Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services, 1998.

《中國循證醫學雜志》

兒童醫療保險覆蓋率擴大策略的系統評價

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《中國循證醫學雜志》

兒童醫療保險覆蓋率擴大策略的系統評價

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