Effect of health insurance on the utilisation of allied health services by people with chronic disease: a systematic review and meta-analysis

Abstract

Abstract. Allied health services benefit the management of many chronic diseases. The effects of health insurance on the utilisation of allied health services has not yet been established despite health insurance frequently being identified as a factor promoting utilisation of medical and hospital services among people with chronic disease. The objective of this systematic review and meta-analysis was to establish the effects of health insurance on the utilisation of allied health services by people with chronic disease. Medline (Ovid Medline 1948 to Present with Daily Update), EMBASE (1980 to 1 April 2011), CINAHL, PsychINFO and the Cochrane Central Register of Controlled Trials were searched to 12 April 2011 inclusive. Studies were eligible for inclusion if they were published in English, randomised controlled trials, quasiexperimental trials, quantitative observational studies and included people with one or more chronic diseases using allied health services and health insurance. A full-text review was performed independently by two reviewers. Meta-analyses were conducted. One hundred and fifty-eight citations were retrieved and seven articles were included in the meta-analyses. The pooled odds ratio (95% CI) of having insurance (versus no insurance) on the utilisation of allied health services among people with chronic disease was 1.33 (1.16À1.52; P < 0.001). There was a significant effect of insurance on the utilisation of non-physiotherapy services, pooled odds ratio (95% CI) 4.80 (1.46À15.79; P = 0.01) but having insurance compared with insurance of a lesser coverage was not significantly associated with an increase in physiotherapy utilisation, pooled odds ratio (95% CI) 1.53 (0.81À2.91; P = 0.19). The presence of co-morbidity or functional limitation and higher levels of education increased utilisation whereas gender, race, marital status and income had a limited and variable effect, according to the study population. The review was limited by the considerable heterogeneity in the research questions being asked, sample sizes, study methodology (including allied health service), insurance type and dependent variables analysed. The presence of health insurance was generally associated with increased utilisation of allied health services; however, this varied depending on the population, provider type and insurance product.Additional keywords: allied health occupations, gatekeeping, primary health care.

Emergency department presentation for uncomplicated acute rhinosinusitis is associated with poor access to healthcare

“…This analysis of a comprehensive national database of outpatient clinic and ED visits for patients with ARS uncovers novel associations highlight-ing healthcare access as well as cultural underpinnings for preferential ED usage in these patients. We found patients with Medicaid and self-pay/no insurance, historically associated with poor access to healthcare, [14][15][16][17][18][19] were more likely to present to an ED for uncomplicated ARS. This observation was independent of our markers for socioeconomic status, which were not associated with ED presentation.…”

“…We found patients with Medicaid and self‐pay/no insurance, historically associated with poor access to healthcare, were more likely to present to an ED for uncomplicated ARS. This observation was independent of our markers for socioeconomic status, which were not associated with ED presentation.…”

Factors Associated to the Enrollment in Health Insurance: An Experience from Selected Districts of Nepal

“…Another study from Ethiopia shows that presence of diseases in HH, income, educational status and first point of treatment were some influencing factors for enrollment in HI and utilization of services as well (Tilahun, Atnafu, Asrade, Minyihun & Alemu, 2018). However, another study indicates that presence of HI is associated with the prompt utilization of health services (Skinner, Foster, Mitchell, & Haynes, 2014). Illiteracy or low level of education, poor social support and homelessness are considered as determinants for non-enrollment in HI (Fowler et al, 2010).…”

Community Health Center Utilization Following the 2008 Medicaid Expansion in Oregon: Implications for the Affordable Care Act

“…Many studies show that utilization of primary care is associated with improved receipt of preventive services, 39–43 effective management of chronic conditions, 44,45 reduced use of expensive emergency and hospital services, 46,47 and improved health outcomes. 48 In Massachusetts and Oregon, primary care access barriers were implicated in increased use of emergency departments after insurance expansion.…”