Effects of Health Insurance Schemes on Utilization of Healthcare Services and Financial Risk Protection: A Systematic Review

Universal health coverage (UHC) assures healthcare utilization and financial risk protection. Health insurance schemes are highly variable in the scope of the benefits package, the magnitude of premiums, deductibles, copayments, and the range of providers and health facilities participating in the networks. The variability has different effects utilization and financial risk protection. This systematic review explores the effect of various models of health insurance on utilization of healthcare services, and financial risk protection. We included 22 studies conducted in 17 countries that implement different health insurance schemes. Overall, evidence on the impact of health insurance on financial protection varied across studies reviewed. Seven studies reported a reduction in out-of-pocket expenditure, two studies had no statistically significant effect; and one study reported an increase in out-of-pocket expenditure. While 14 studies found a positive effect on healthcare utilization, six studies had no statistically significant impact on utilization of healthcare. The findings of this review show that enrollment in various insurance schemes can protect households and individuals from catastrophic out-of-pocket spending and increase healthcare utilization. The consistent evidence of the positive effects of health insurance highlights the need to explore creative and responsive insurance schemes contextualized to meet the needs of different groups and achieve UHC.