Impact of community-based health insurance in low- and middle-income countries: A systematic review and meta-analysis

Paul Eze; Stanley Ilechukwu; Lucky Osaheni Lawani

doi:10.1371/journal.pone.0287600

Peer Review History

Original SubmissionNovember 28, 2022
4 Apr 2023 Decision Letter - Lara Vojnov, Editor PONE-D-22-32762Impact of community-based health insurance in low- and middle-income countries: A systematic review and meta-analysisPLOS ONE Dear Dr. Eze, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by May 19 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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[Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This is a very useful review and contribution to the literature. It can be further improved by a few additional elements in the analysis 1. The authors report the effects on health care utilization but do not detail any of the information on data sources; how much was gleaned from surveys versus other forms of health care utilization? were all trials equal? any disaggregation by age groups impacted (effects on women, children and elderly)? 2. Is there further evidence of impact by gender or geography? I note the higher impact in public sector or government led programs but were any differences notable by urban or rural settings? 3. One notes the effects were not significant on inpatient utilization? does that reflect maternity care as well? 4. Noting the bulk of studies being from China, did the authors conduct a sensitivity analysis with and without these data? Reviewer #2: This is a nice paper. I am not an expert in meta-analysis so the paper should be reviewed by a statistician. However, overall the paper is extremely well written and detailed with close attention to detail • Table 2 is mislabeled as Table 3 • I suggest being explicit about financial risk protection measures under the “data analysis” paragraph rather than waiting to results section to describe • Metanalysis Figures seem very low resolution and are hard to read. This may be an issue with the submission platform compressing files for review but will need to be doublechecked • Figure 4-6 readability would be better if labels “A” “B” etc were replaced by descriptive labels. • I think the phrase "even though several indicated otherwse” could be eliminated from the abstract • I’d also suggest eliminated the "The governmentsupported community-involved model relatively had the greatest impact” reference in the abstract; since this taxonomy isn’t introduced here it is hard to understand • The last two paragraphs of the conclusion (discusing health utilization and financial risk) could be a bit more definitive about what this study shows. Study findings are interwoven with literature in a way that doesn’t immediately make clear how the study clears up some of the debates in the literature. The paragraph on financial risk in particular is mostly negative on the impact of CBHI despite the postiive findings of the meta-analysis reported here. ****** 6. 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Revision 1
10 May 2023 Author Response Manuscript Number: PONE-D-22-32762 Title: Impact of community-based health insurance in low- and middle-income countries: A systematic review and meta-analysis Dear Dr. Lara Vojnov, PhD Academic Editor PLOS ONE We are very grateful to the editorial team and the reviewers for their useful comments on our manuscript. Their suggestions have greatly enhanced the quality of our manuscript. All modifications and corrections have been made as recommended. Below are our responses to the reviewers’ comments. Journal requirements #1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf. Authors’ response We have made all required changes to meet PLOS ONE’s style requirements. #2. We note that Figure 2 in your submission contain [map/satellite] images which may be copyrighted. All PLOS content is published under the Creative Commons Attribution License (CC BY 4.0), which means that the manuscript, images, and Supporting Information files will be freely available online, and any third party is permitted to access, download, copy, distribute, and use these materials in any way, even commercially, with proper attribution. For these reasons, we cannot publish previously copyrighted maps or satellite images created using proprietary data, such as Google software (Google Maps, Street View, and Earth). For more information, see our copyright guidelines: http://journals.plos.org/plosone/s/licenses-and-copyright We require you to either (1) present written permission from the copyright holder to publish these figures specifically under the CC BY 4.0 license, or (2) remove the figures from your submission: a. You may seek permission from the original copyright holder of Figure 2 to publish the content specifically under the CC BY 4.0 license. We recommend that you contact the original copyright holder with the Content Permission Form (http://journals.plos.org/plosone/s/file?id=7c09/content-permission-form.pdf) and the following text: “I request permission for the open-access journal PLOS ONE to publish XXX under the Creative Commons Attribution License (CCAL) CC BY 4.0 (http://creativecommons.org/licenses/by/4.0/). Please be aware that this license allows unrestricted use and distribution, even commercially, by third parties. Please reply and provide explicit written permission to publish XXX under a CC BY license and complete the attached form.” Please upload the completed Content Permission Form or other proof of granted permissions as an "Other" file with your submission. In the figure caption of the copyrighted figure, please include the following text: “Reprinted from [ref] under a CC BY license, with permission from [name of publisher], original copyright [original copyright year].” b. If you are unable to obtain permission from the original copyright holder to publish these figures under the CC BY 4.0 license or if the copyright holder’s requirements are incompatible with the CC BY 4.0 license, please either i) remove the figure or ii) supply a replacement figure that complies with the CC BY 4.0 license. Please check copyright information on all replacement figures and update the figure caption with source information. If applicable, please specify in the figure caption text when a figure is similar but not identical to the original image and is therefore for illustrative purposes only. The following resources for replacing copyrighted map figures may be helpful: USGS National Map Viewer (public domain): http://viewer.nationalmap.gov/viewer/; The Gateway to Astronaut Photography of Earth (public domain): http://eol.jsc.nasa.gov/sseop/clickmap/; Maps at the CIA (public domain): https://www.cia.gov/library/publications/the-world-factbook/index.html and https://www.cia.gov/library/publications/cia-maps-publications/index.html; NASA Earth Observatory (public domain): http://earthobservatory.nasa.gov/; Landsat: http://landsat.visibleearth.nasa.gov/; USGS EROS (Earth Resources Observatory and Science (EROS) Center) (public domain): http://eros.usgs.gov/#; Natural Earth (public domain): http://www.naturalearthdata.com/ Authors’ response Thanks very much for this information. We actually obtained our base layer map from Natural Earth and included a statement credit to Natural Earth in the manuscript (see page 20). Reviewer #1 #1. The authors report the effects on health care utilization but do not detail any of the information on data sources; how much was gleaned from surveys versus other forms of health care utilization? were all trials equal? any disaggregation by age groups impacted (effects on women, children and elderly)? Authors’ response Thanks for this recommendation. We have provided more information on study design and age groups in Table 3 and in the results section. #2. Is there further evidence of impact by gender or geography? I note the higher impact in public sector or government led programs but were any differences notable by urban or rural settings. Authors’ response Thanks very much for this recommendation. We have provided evidence of impact by setting (rural or urban) in Table 3 and in the results section, but we could not extract evidence of impact in included studies by gender. #3. One notes the effects were not significant on inpatient utilization? does that reflect maternity care as well? Authors’ response No, we noted that CBHI improved maternity inpatient utilization. However, the only study that specifically looked at Caesarean delivery showed that CBHI decreased Caesarean delivery rate – highlighted in blue (page 6). #4. Noting the bulk of studies being from China, did the authors conduct a sensitivity analysis with and without these data? Authors’ response Thanks for this observation. Yes, we conducted sensitivity analysis with and without these data from China and did not obtain different results for both healthcare utilization and financial risk protection outcomes. We have noted these in the results and discussion sections Reviewer #2 #1. Table 2 is mislabeled as Table 3 Authors’ response Thank you for this observation. We have corrected this. #2. I suggest being explicit about financial risk protection measures under the “data analysis” paragraph rather than waiting to results section to describe Authors’ response Thanks very much for this suggestion. We have provided more details on the financial risk protection measures under the “data analysis” paragraph. #3. Metanalysis Figures seem very low resolution and are hard to read. This may be an issue with the submission platform compressing files for review but will need to be doublechecked Authors’ response We double checked our meta-analysis figures and they are actually clear; we think it is the submission platform compressing the files for review. #4. Figure 4-6 readability would be better if labels “A” “B” etc were replaced by descriptive labels. Authors’ response Thanks for the recommendation. We have included descriptive labels to improve readability. #5. I think the phrase "even though several indicated otherwise” could be eliminated from the abstract Authors’ response Thanks for the recommendation. Done. #6. I’d also suggest eliminated the "The government-supported community-involved model relatively had the greatest impact” reference in the abstract; since this taxonomy isn’t introduced here it is hard to understand Authors’ response Thanks for the recommendation. Done. #7. The last two paragraphs of the conclusion (discussing health utilization and financial risk) could be a bit more definitive about what this study shows. Study findings are interwoven with literature in a way that doesn’t immediately make clear how the study clears up some of the debates in the literature. The paragraph on financial risk in particular is mostly negative on the impact of CBHI despite the positive findings of the meta-analysis reported here. Authors’ response Thank you very much for this observation. We were careful to avoid exaggerating the impact of CBHI, but we have revised these paragraphs to be clearer on the positive findings. We are very thankful to the PLOS ONE editorial team and reviewers for the extremely valuable recommendations. Thanks very much. Paul Eze MD., MPH Tel: +1 223 216 1640 (USA) University email: peze@psu.edu / Personal email: peze247@yahoo.com On behalf of all the authors: 1. Dr. Paul Eze, Pennsylvania State University, University Park, USA 2. Dr. Stanley Ilechukwu, London School of Hygiene and Tropical Medicine, London, UK., and South Sahara Development Organization (SSDO), Enugu, Nigeria. 3. Professor Lucky Osaheni Lawani, University of Toronto, Toronto, Canada https://doi.org/10.1371/journal.pone.0287600.r002
8 Jun 2023 Decision Letter - Lara Vojnov, Editor Impact of community-based health insurance in low- and middle-income countries: A systematic review and meta-analysis PONE-D-22-32762R1 Dear Dr. Eze, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Lara Vojnov Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0287600.r003
Formally Accepted
15 Jun 2023 Acceptance Letter - Lara Vojnov, Editor PONE-D-22-32762R1 Impact of community-based health insurance in low- and middle-income countries: A systematic review and meta-analysis Dear Dr. Eze: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Lara Vojnov Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0287600.r004

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