经济能力审查法在卫生项目人群识别中的应用评价

Means Testing for Targeting Population in Health Programs:A Systematic Review

目的描述和分析卫生服务项目中识别贫困人群的经济能力审查方法,描述作者如何评价经济能力审查办法的效果。方法检索24个循证类、卫生类、经济类、社会类等数据库,7个国际机构网站、灰色文献网站和Google搜索引擎。文献筛选和数据提取分别由两人独立完成,不同意见由第三人裁定或者小组讨论决定。利用主题分析法,对纳入研究以国家、人群、审查法等维度进行系统分析,对经济能力审核方法的效果进行评价。结果最初共检到10 244条记录,通过文题、摘要和全文筛选两个阶段,最终纳入58个研究。其中,13篇文献描述了美国利用经济能力精确调查法(VMT)作为人群甄别方法,16个国家应用经济能力简单审查法(SMT),26篇文献描述了经济能力间接审查法(PMT)在14个国家的应用,14个国家应用了经济能力混合审查法(MA);纳入文献中主要涉及4类卫生项目利用了经济能力审查方法来甄别其目标人群,包括医疗保险、现金转移支付、卫生服务免费提供项目和差别费项目等;大部分目标人群为贫困人口。纳入文献中,分别有3篇和11篇文献分析了卫生项目中实施经济收入能力审查方法的未覆盖率和漏出率,而有关实施经济能力审查的管理成本信息很少。结论经济能力审查法现应用于多种卫生项目,已成为甄别目标人群、实现利益再分配的方法,尤其在发展中国家应用广泛。人群识别方法在发展中国家已成为预算限制条件下有效分配卫生资源的重要方式。当今,全面覆盖策略已成为世界性问题,而如何将现有资源公平、有效地进行分配和使用成为政策实施的重要问题。而经济能力评价审查法作为一种人群识别工具,将有助于政策实施。

Objectives To describe the mechanism of means testing used in health programs for targeting poor population and to describe how the authors have assessed e ects of means testing approaches where applicable.Method We searched 24 electronic resources which included evidence-based,health,economic and social databases,7 international institution websites,grey literature review resources and Google.Screening and data extraction were conducted by two reviewers separately,and the di erences were discussed by the third person or a review group.We systematically analyzed the included studied by theme analysis method from di erent dimensions.We also described the evaluation outcomes by the authors.Result A total of 10244 records were searched,and 58 studies were included a er screening by title,abstract and full texts.A total of 13 studies described verified means testing（VMT） conducted as a targeting method in the US;simple testing method（SMT） was conducted in 16 countries;26 studies described how proxy means testing（PMT） was used in 14 countries;and mixed means testing（MA） was conducted in 14 countries.Means testing as a targeting method was widely used in four health programs which included health insurance,cash transfer,provision of free health service and fee structure.The target population was poor.Only few studies analyzed the outcomes of means testing;3 studies analyzed under-coverage and 11 studies analyzed leakage as their indicators.Scare cost information could be obtained from the included studies.Conclusion Means testing is widely used in various health programs for targeting the eligible population in distributing bene ts,especially in developing countries.Targeting as a means for allocating health resources is particularly important in LMICs for their constraints in budgets available for health.Meanwhile,a universal coverage strategy has become a worldwide issue,and how current health resources can be used equitably and e ciently is a concern from the policy practice.Means testing,as one of the tools in targeting eligible population,would help in this process.