Effect of health insurance on the utilisation of allied health services by people with chronic disease: a systematic review and meta-analysis
Elizabeth H. Skinner A B F , Michele Foster C , Geoffrey Mitchell D , Michele Haynes E , Martin O’Flaherty E and Terry P. Haines A BA Department of Physiotherapy, Monash Health, 246 Clayton Road, Clayton, Melbourne, Vic. 3168, Australia.
B Department of Physiotherapy, School of Primary Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, PO Box 527, Frankston, Vic. 3199, Australia.
C Postgraduate Research Studies, School of Social Work and Human Services, The University of Queensland, Mansfield Place, St Lucia, Brisbane, Qld 4072, Australia.
D General Practice and Palliative Care, MBBS Program, The University of Queensland, Building 12, Ipswich Campus, Salisbury Road, Ipswich, Qld 4305, Australia.
E Institute for Social Science Research, General Purpose North Building 4, The University of Queensland, Mansfield Place, St Lucia, Brisbane, Qld 4072, Australia.
F Corresponding author. Email: elizabeth.skinner@wh.org.au
Australian Journal of Primary Health 20(1) 9-19 https://doi.org/10.1071/PY13092
Submitted: 2 July 2013 Accepted: 7 August 2013 Published: 1 October 2013
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, quasi-experimental 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 (1.16−1.52; P < 0.001). There was a significant effect of insurance on the utilisation of non-physiotherapy services, pooled odds ratio (95% CI) 4.80 (1.46−15.79; 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 (0.81−2.91; 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.
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