Background Whilst several systematic reviews conducted in Low- and Middle-Income Countries (LMICs) have revealed that coverage under social (SHI), national (NHI) and community-based (CBHI) health insurance has led to increased utilization of health care services, it remains unknown whether, and what aspects of, these shifts in financing result in improvements to mental health care utilization. The main aim of this review was to examine the impact of SHI, NHI and CBHI enrollment on mental health care utilization in LMICs. Methods Systematic searches were performed in nine databases of peer-reviewed journal articles: Pubmed, Scopus, SciELO via Web of Science, Africa Wide, CINAHL, PsychInfo, Academic Search Premier, Health Source Nursing Academic and EconLit for studies published before October 2018. The quality of the studies was assessed using the Effective Public Health Practice Project quality assessment tool for quantitative studies. The systematic review was reported according to the PRISMA guidelines (PROSPERO;2018; CRD42018111576). Results Eighteen studies were included in the review. Despite some heterogeneity across countries, the results demonstrated that enrollment in SHI, CBHI and NHI schemes increased utilization of mental health care. This was consistent for the length of inpatient admissions, number of hospitalizations, outpatient use of rehabilitation services, having ever received treatment for diagnosed schizophrenia and depression, compliance with drug therapies and the prescriptions of more favorable medications and therapies, when compared to the uninsured. The majority of included studies did not describe the insurance schemes and their organizational details at length, with limited discussion of the links between these features and the outcomes. Given the complexity of mental health service utilization in these diverse contexts, it was difficult to draw overall judgements on whether the impact of insurance enrollment was positive or negative for mental health care outcomes. Conclusions Studies that explore the impact of SHI, NHI and CBHI enrollment on mental health care utilization are limited both in number and scope. Despite the fact that many LMICs have been hailed for financing reforms towards universal health coverage, evidence on the positive impact of the reforms on mental health care utilization is only available for a small sub-set of these countries.

中文翻译：

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社会、国家和社区健康保险对低收入和中等收入国家精神、神经和药物滥用疾病医疗保健利用的影响：系统评价。

背景 虽然在低收入和中等收入国家 (LMIC) 进行的几项系统审查显示，社会 (SHI)、国家 (NHI) 和社区 (CBHI) 健康保险的覆盖范围导致医疗保健服务的利用率增加，目前尚不清楚这些融资方式的转变是否以及哪些方面会导致精神卫生保健利用率的改善。本次综述的主要目的是研究 SHI、NHI 和 CBHI 入学对中低收入国家精神卫生保健利用的影响。方法 在 9 个同行评审期刊文章数据库中进行系统检索：Pubmed、Scopus、SciELO via Web of Science、Africa Wide、CINAHL、PsychInfo、Academic Search Premier、Health Source Nursing Academy 和 EconLit，查找 2018 年 10 月之前发表的研究。使用有效公共卫生实践项目定量研究质量评估工具对研究质量进行评估。系统评价根据 PRISMA 指南进行报告（PROSPERO；2018；CRD42018111576）。结果 十八项研究纳入评价。尽管各国之间存在一些差异，但结果表明，参加 SHI、CBHI 和 NHI 计划增加了精神卫生保健的利用率。与未投保的人相比，住院时间、住院次数、门诊康复服务使用情况、是否曾接受过诊断为精神分裂症和抑郁症的治疗、药物治疗依从性以及更有利的药物和疗法的处方都是一致的。大多数纳入的研究没有详细描述保险计划及其组织细节，对这些特征和结果之间的联系的讨论也很有限。鉴于这些不同背景下心理健康服务利用的复杂性，很难就参保对心理健康护理结果的影响是积极还是消极做出总体判断。结论 探讨 SHI、NHI 和 CBHI 入学对精神卫生保健利用影响的研究在数量和范围上都有限。尽管许多中低收入国家因资助全民健康覆盖改革而受到欢迎，但只有这些国家的一小部分能够获得有关改革对精神卫生保健利用产生积极影响的证据。