Introduction

Non-communicable diseases (NCDs) include four disease clusters: cardiovascular diseases, diabetes, cancer and chronic obstructive pulmonary diseases.[1-4] These clusters contribute to the highest morbidity burden globally4 and are the leading causes of premature mortality worldwide.4-6 They account for 73% of mortality deaths globally,7 of which most reported mortality could be prevented.3,7 NCDs are linked to four lifestyle risk factors: tobacco smoking, poor diet, physical inactivity and alcohol consumption.4,8,9 A healthy lifestyle has been known to reduce the risks of developing NCDs.10-13 A cohort study by Lv et al.12 among Chinese adults has shown that about three out of four incidences of Type 2 diabetes could be avoided in <10 years with adherence to a healthy lifestyle. In a similar study in China, non-smoking, moderate alcohol intake, physical activity and a healthy diet were associated with lower risks of major coronary events and ischemic stroke.11

Health insurance (HI) is a means to finance health care expenses by risk and resource pooling,14,15 which is more likely to be efficient and equitable than the ‘out-of-pocket’ health payment method.14 The effect of HI on healthy lifestyle choices and health outcomes is not well established to date. The available evidences are inconclusive. Some studies claim HI increases the propensity to engage in a healthy lifestyle,16-18 while others claim HI decreases the propensity to engage in a healthy lifestyle.19,20 In contrast, some studies found that HI does not affect healthy lifestyle choices and health outcomes.21,22

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However, there is a risk that HI may induce Ex-ante moral hazard. Ex-ante moral hazard occurs when HI reduces an individual interest in protective behaviours. Ex-ante moral hazard is not an intended outcome of HI23 but a possible outcome of HI.13,24 On the other hand, there could be a case of propitious selection where an individual purchases HI and still engages in a healthy lifestyle.1 This is a likely situation for people with high risk-averse who would like to avoid risk as much as possible. Ex-ante moral hazard could induce unhealthy lifestyles, precipitate NCDs related risk factors and subsequently lead to the incidence of NCDs. Considering the link between a healthy lifestyle and the incidence of NCDs, it is important to understand the effect of HI on lifestyle.

The primary aim of this systematic review is to review and summarize research that examined the effect of HI on healthy lifestyle choices and the presence of NCDs. This is to establish if HI is beneficial for healthy lifestyle choices and outcomes related to NCDs. This will provide information that can be used to develop effective policy reforms that can optimize HI plans.

Source: https://t-tees.com
Category: WHY