Title Registration Form Campbell Collaboration Social Welfare Coordinating Group

Transcription

1 Title Registration Form Campbell Collaboration Social Welfare Coordinating Group 1. Title of review (Suggested format: [intervention/s] for [outcome/s] in [problem/population] in [location/situation] Example: behavioural therapy for reducing violence among adolescents in institutions) Social health insurance for improving access to care for disabled and elderly people in developing countries 2. Background and objective of this review (Briefly describe the problem and the intervention) The elderly and the disabled like most disadvantaged groups, often have to pay higher premiums for health insurance than the general population (AHIP Centre for Policy and Research s Individual Insurance Survey Report 2005). This condition usually leads to low health insurance coverage for these groups of people and may affect their ability to access healthcare, in view of the fact that they are not the most economically productive group of the general population. This review seeks to explore the possible role of social health insurance in solving this problem. Social health insurance in our context refers to the mechanism of funding health care which involves compulsory membership among all of the population. Workers, self-employed, enterprises and government pay contributions into a social health insurance fund. The base for workers and enterprises contributions is usually the worker s salary. The contributions of self-employed persons are either flat-rate or based on estimated income. Government may provide contributions for those who otherwise would not be able to pay, such as unemployed people and low-income informal economy workers. SHI owns its own provider networks, works with accredited public and private healthcare providers, or uses a combination of both (Carrin et al 1994). With the gradual popularity of this funding mechanism especially among Low and Middle Income Countries (discussed below), it may be worthwhile to study the effects of this funding mechanism on the disadvantaged groups in the population. Other types of health insurance include private health insurance, in which individuals pay for their health care to private insurance companies and Health Insurance by tax revenue in which the government pays for the health needs of the population from the proceeds of the tax collected from the populace. This review seeks to assess the effects of social health insurance on improving access to care for the elderly and the disabled. Other health insurance or health finance models are also feasible alternatives, 1

2 but this review will be restricted to the effects of social health insurance focusing specifically on the selected population of the elderly and the disabled. 3. Define the population (Who is included and who is excluded?) The elderly are a difficult group to define. There have been many attempts to define the elderly. For the purpose of this review, we adopt the definition of the U.S. National Institute on Aging and the World Health Organization s MDS project (Information Needs for Research, Policy and Action on Ageing and Older Persons in sub-saharan Africa: the Minimum Data Set Project) who broadly defined the elderly as people above the age of 50 years, as an all inclusive definition, taking into consideration, the variation in the meaning of the term across different cultures. Disability has been defined by the World Health Organization s International Classification of Impairments, Disabilities and Handicaps (ICIDH), (1980) as any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being. Thus the disabled will involve the mentally ill and the mentally retarded, the visually, hearing and speech impaired, those with restricted mobility or with so-called medical disabilities. It has been shown that the elderly and the disabled constitute the major component of health care expenditure and so are sidelined by most health care plans. We intend to investigate to see if Social Health Insurance may be a viable alternative to the traditional health insurance plans. The population of the elderly and the disabled who represent the economically disadvantaged groups in the population will be studied in the context of the Low and Middle Income countries (LMICs). The LMICs are defined by the World Bank in the website, upk: ~pagepk: ~pipk: ~thesitepk:239419,00.html (as at 21April 2009) For the purpose of this review, developed countries will not be considered as they have established health care systems and compared to LMICs, grapple less with the problems of reduced access to care for the elderly and disabled. Low income people are also not considered, because the authors feel that the term does not fully represent the disabled and elderly and they may not necessarily need as much care or be excluded from health care plans as much as the elderly and the disabled. 2

3 4. Define the intervention/s (What is given, by whom, and for how long? What are the comparison conditions?) Social health insurance (as defined above) compared to no intervention for improving access to healthcare and the health outcomes of the elderly and the disabled. Private health insurance and tax-based health insurance are not included in this review. 5. Outcome/s (What are the intended effects of the intervention? Primary and secondary outcomes should all be mentioned.) Primary Outcomes: 1. Access to healthcare service utilization 2. Management of associated co-morbid conditions 3. Mortality and life expectancy Secondary outcomes: 1. Financial burden of disease on the family. 2. Burden on care-givers 3. Quality of life and ability to live an independent life 6. Methodology (What types of studies are to be included and excluded? Please describe eligible study designs, control/comparison groups, measures, and duration of follow-ups.) Randomised controlled trials, interrupted time-series analysis (which must meet the EPOC group criteria of stating clearly a defined point in time when the intervention occurred and at least three data points before and three after the intervention), parallel cohort designs with matching or statistical controls for baseline differences. 7. Review team (List names of those who will be cited as authors on the final publication) Lead reviewer This is the person who develops and co-ordinates the review team, discusses and assigns roles for individual members of the review team, liaises with the editorial base and takes responsibility for the on-going updates of the review Okebukola Oluseyi Peter Title: Dr. National health Insurance Scheme Address: Plot 297, Yar Adua Way, Utako District City: Abuja State, Province or County: F.C.T. Postal Code: 0000 Country: NIGERIA 3

4 There should be at least one co-author Phone: Mobile: Dr. Jimlas O. Ogunsakin Eureka Capacity Development Foundation 8. Roles and responsibilities Please give brief description of content and methodological expertise within the review team. It is recommended to have at least one person on the review team who has content expertise, at least one person who has methodological expertise and at least one person who has statistical expertise. It is also recommended to have one person with information retrieval expertise. Please note that this is the recommended optimal review team composition. Content: Dr. Peter Okebukola Systematic review methods: Statistical analysis: Information retrieval: 9. Potential conflicts of interest (E.g., have any of the authors been involved in the development of relevant interventions, primary research, or prior published reviews on the topic?) NO 10. Support Do you need support in any of these areas: methodology and causal inference, systematic searches, coding, statistics (meta-analysis)? 4

5 Yes. In areas of systematic searches and meta-analysis (as an addition to the skills of the authors) 11. Funding Do you receive any financial support? If so, where from? If not, are you planning to apply for funding? Where? We do not currently receive any financial support from anywhere but will be grateful for such. 11. Preliminary timeframe Approximate date for submission of Draft Protocol (please note this should be no longer than 6 month after title approval. If the protocol is not submitted by then, the review area is opened up for other reviewers): 24 th December, 2009 Title registration submission date: 8 th February, 2009, re-submitted 2 nd June 2009 Title registration approval date: 8 th of June