Understanding Role of Insurance on Health Care Utilization and Expenditure: A Scoping Review

Abstract

Universal Health Coverage places strong emphasis on health insurance as a strategy to ensure need-based care without financial hardship, yet its direct impact on healthcare utilization and expenditure remains unclear. This scoping review maps recent evidence on how insurance influences both service use and out‑of‑pocket expenditure (OOPE), including catastrophic health expenditure(CHE) , by examining studies published between 2018 and early 2024. Using the Population, Concept, Context (PCC) framework and PRISMA‑Scr checklist, the review included only studies that reported both utilization and expenditure outcomes within the same context. Ten eligible studies were identified. Overall, the findings indicate that enrolment in health insurance schemes generally increases healthcare utilization, although the effect varies by type of service and is not universal across all care categories. Evidence also shows that insurance contributes to reducing OOPE, but the magnitude of this effect depends heavily on the design and generosity of the insurance scheme. In contrast, CHE does not demonstrate a clear or consistent association with insurance coverage, suggesting gaps in financial protection. These results highlight the need for policy attention to benefit package design, depth of coverage, and inclusion of diverse service types to strengthen financial risk protection across different health system settings.