"Social Health Insurance and Universal Health Coverage in Asia" by Afaf Jauhar and Mardiati Nadjib
  •  
  •  
 

Abstract

Universal Health Coverage (UHC) aims to ensure that all individuals have access to essential health services without financial hardship. Social Health Insurance (SHI) is critical in achieving this goal, especially in low- and middle-income countries. This systematic review explores the role of SHI systems in advancing UHC across 14 Asian countries, focusing on healthcare access, financial protection, and equity. A comprehensive search across PubMed, Scopus, and ScienceDirect identified 768 articles, and 37 studies were selected after screening, following the PRISMA guidelines. The chosen studies cover countries with varying SHI models across Asia. The findings reveal that high-income countries such as Japan, South Korea, and Singapore have made notable progress toward UHC. However, they face challenges related to aging populations and financial sustainability. In Thailand, the Universal Coverage Scheme (UCS) has achieved near-universal coverage, while Malaysia and Indonesia struggle with rural healthcare access and specialized care. In lower-middle-income countries like India, Vietnam, and Bangladesh, progress in financial protection is evident, but gaps persist in outpatient care and equitable access. Nepal and Cambodia face significant barriers due to economic and geographical constraints. This review underscores the critical role of SHI in advancing UHC. It highlights the need for policy reforms, innovative financing, and targeted interventions to strengthen SHI systems and improve equitable healthcare access across all Asian populations.

References

Acharya, D. et al. (2023) 'Causes of dropout from health insurance program: An experience from Lumbini Province, Nepal', Dialogues in Health, 3, p. 100150.

Agustina, R. et al. (2019) 'Universal health coverage in Indonesia: concept, progress, and challenges', The Lancet, 393, pp. 75–102.

Angell, B.J., Prinja, S., Gupt, A., Jha, V. and Jan, S. (2019) 'The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana and the path to universal health coverage in India: Overcoming the challenges of stewardship and governance', PLoS Medicine, 16(3), e1002759.

Annear, P., Ir, P. and Jacobs, B. (n.d.) 'The Kingdom of Cambodia health system review'. Available at: https://www.researchgate.net/publication/275345999 (Accessed: 21 Deciember 2024).

Annear, P.L. et al. (2019) 'Protecting the poor? Impact of the National Health Equity Fund on utilization of government health services in Cambodia, 2006-2013', BMJ Global Health, 4(6). Available at: https://pubmed.ncbi.nlm.nih.gov/31798986/

Ayer, R., Tiwari, S., Jnawali, S.P. and Van Dael, R. (2024) 'A study on Nepal’s National Health Insurance Program May 2024', Journal of Health Systems and Policy, 2030.

Chan, C.Q.H., Lee, K.H. & Low, L.L. (2018) 'A systematic review of health status, health-seeking behaviour and healthcare utilisation of low socioeconomic status populations in urban Singapore', International Journal for Equity in Health, 17(1). Available at: https://pubmed.ncbi.nlm.nih.gov/29609592/

Chua, H.T. & Cheah, J.C.H. (2012) 'Financing universal coverage in Malaysia: A case study', BMC Public Health.

Department of Economic and Social Affairs (n.d.) Transforming our world: the 2030 Agenda for Sustainable Development. Available at: https://sdgs.un.org/2030agenda (Accessed: 21 December 2024).

Duc Thanh, N. et al. (2021) 'Impact of public health insurance on out-of-pocket health expenditures of the near-poor in Vietnam', Health Services Insights, 14.

Eichler, R., Gigli, S. & Leroy, L. (n.d.) 'Implementation research to strengthen health care financing reforms toward universal health coverage in Indonesia: A mixed-methods approach to real-world monitoring', Global Health: Science and Practice. Available at: www.ghspjournal.org

Forman, R. et al. (2022) 'Sehat Sahulat: A social health justice policy leaving no one behind'. Available at: https://doi.org/10.1016/j.

Grewal, H., Sharma, P., Dhillon, G., Munjal, R.S., Verma, R.K. and Kashyap, R. (2023) 'Universal health care system in India: An in-depth examination of the Ayushman Bharat initiative', Cureus, 15(6), e38429.

Hasan, M.Z., Ahmed, S., Mehdi, G.G., Ahmed, M.W., Arifeen, S.E. and Chowdhury, M.E. (2024) 'The effectiveness of a government-sponsored health protection scheme in reducing financial risks for the below-poverty-line population in Bangladesh', Health Policy and Planning, 39(3), pp. 281–298.

Hasan, S.S., Mustafa, Z.U., Kow, C.S. and Merchant, H.A. (2022) 'Sehat Sahulat Program: A leap into the universal health coverage in Pakistan', International Journal of Environmental Research and Public Health, 19, p. 9782.

Hondo, D. & Kim, Y. (2023) 'Achieving universal health coverage in developing Asia and the Pacific'. Available at: https://www.adb.org/publications/achieving-universal-health-coverage-in-developing-asia-and-the-pacific

Hort, K., Jayasuriya, R. and Dayal, P. (2017) 'The link between UHC reforms and health system governance: lessons from Asia', Journal of Health Organization and Management, 31(3), pp. 270–285.

Ikegami, N. (2016) 'Achieving universal health coverage by focusing on primary care in Japan: Lessons for low- and middle-income countries', International Journal of Health Policy and Management, 5, pp. 291–293.

Ikegami, N. (2019) 'Japan: achieving UHC by regulating payment', Globalization and Health, 15.

Jamal, M.H. et al. (2022) 'Successes and obstacles in implementing social health insurance in developing and middle-income countries: A scoping review of 5-year recent literatures'. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC9648174

Khan, S.A., Cresswell, K. and Sheikh, A. (2022) 'Contextualising Sehat Sahulat Programme in the drive towards universal health coverage in Khyber Pakhtunkhwa, Pakistan', Khyber Medical University Journal, 14, pp. 63–70.

Khanal, G.N. et al. (2023) 'Evaluation of the National Health Insurance Program of Nepal: Are political promises translated into actions?', Health Research Policy and Systems, 21(1), pp. 1–26. Available at: https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-022-00952-w

Lahariya, C. (2018) 'Ayushman Bharat Program and universal health coverage in India', National Health Policy, 495, pp. 1–10.

Lee, Y., Kim, S., Kim, S.Y. and Kim, G. (2019) 'Ethical consideration of national health insurance reform for universal health coverage in the Republic of Korea', Asian Bioethics Review, 11(1), pp. 41–56.

Le, Q.N., Blizzard, L., Si, L., Giang, L.T. and Neil, A.L. (2020) 'The evolution of social health insurance in Vietnam and its role towards achieving universal health coverage', Health Policy Open, 1, p. 100011.

Lim, M.Y. et al. (2023) 'Health financing challenges in Southeast Asian countries for universal health coverage: a systematic review', Archives of Public Health, 81(1).

Lu, J-F.R., Sheu, J.T. and Lee, T.J. (2022) 'A tale of two social insurance systems in South Korea and Taiwan: A financial risk protection perspective', Health Systems & Reform, 8(1).

Machida, M. & Miyashita, Y. (2021) 'For further collaboration on strengthening Universal Health Coverage (UHC): Partnership project between Japan and Thailand', Global Health & Medicine, 3(1), pp. 11–14.

Mboi, N. (2015) 'Indonesia: On the way to universal health care', Health Systems & Reform, 1(2), pp. 91-97.

Mao, W. et al. (2020) 'Advancing universal health coverage in China and Vietnam: Lessons for other countries', BMC Public Health, 20(1).

Myint, C.Y. et al. (2019) 'A systematic review of the health-financing mechanisms in the association of Southeast Asian nations countries and the People’s Republic of China: Lessons for the move towards universal health coverage', PLoS ONE, 14.

Nakatani, H. (2019) 'Population aging in Japan: policy transformation, sustainable development goals, universal health coverage, and social determinants of health', Global Health & Medicine, 1(1), pp. 3–10. Available at: https://pubmed.ncbi.nlm.nih.gov/33330747/

Obermann, K., Jowett, M. and Kwon, S. (2018) ‘The role of national health insurance for achieving UHC in the Philippines: A mixed methods analysis’, Global Health Action, 11(1).

OECD (2017) Health at a Glance 2017. Available at: https://www.oecd.org/en/publications/health-at-a-glance-2017_health_glance-2017-en.html (Accessed: 21 December 2024).

Pokharel, R. and Silwal, P.R. (2018) ‘Social health insurance in Nepal: A health system departure toward the universal health coverage’, International Journal of Health Planning and Management, 33(3), pp. 573–580.

Rahman, T., Gasbarro, D. & Alam, K. (2022) 'Financial risk protection in health care in Bangladesh in the era of Universal Health Coverage', PLoS One, 17(6 June).

Ranabhat, C.L. et al. (2019) 'Challenges and opportunities towards the road of universal health coverage (UHC) in Nepal: A systematic review', Archives of Public Health, 77.

Reich, M.R., Takemi, K., Roberts, M.J. and Hsiao, W.C. (2008) ‘Global action on health systems: a proposal for the Toyako G8 summit’, The Lancet, 371(9615), pp. 865–869. Available at: https://pubmed.ncbi.nlm.nih.gov/18328932/ (Accessed: 21 December 2024).

Singapore | International Health Care System Profiles | Commonwealth Fund (n.d.) Available at: https://www.commonwealthfund.org/international-health-policy-center/countries/singapore.

Stern, C., Jordan, Z. & McArthur, A. (2014) 'Developing the review question and inclusion criteria', American Journal of Nursing, 114(4), pp. 53-56.

Tan, K.B., Tan, W.S., Bilger, M. and Ho, C.W.L. (2014) ‘Monitoring and evaluating progress towards universal health coverage in Singapore’, PLoS Medicine, 11(3).

Tang, W., Tran, T., Pender, M., Khanh, P.N. and Tang, S. (2020) ‘Advancing universal health coverage in China and Vietnam: lessons for other countries’, BMC Public Health, 20(1). Available at: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-09130-7 (Accessed: 21 December 2024).

Tangcharoensathien, V., Limwattananon, S., Patcharanarumol, W. and Thammatacharee, J. (n.d.) ‘Monitoring and evaluating progress towards universal health coverage in Thailand’, PLoS Medicine. Available at: www.plosmedicine.org (Accessed: 21 December 2024).

Tao, W. et al. (2020) 'Towards universal health coverage: Lessons from 10 years of healthcare reform in China', BMJ Global Health, 5.

Vuong, Q.H. et al. (2021) 'Good budget or good care: The dilemma of social health insurance in Vietnam', SAGE Open Medicine, 9. Available at: https://journals.sagepub.com/doi/10.1177/20503121211042512.

Wee, L.E. et al. (2014) 'Choice of primary health care source in an urbanized low-income community in Singapore: A mixed-methods study', Family Practice, 31(1), pp. 81–91. Available at: https://pubmed.ncbi.nlm.nih.gov/24253204/.

Wenang, S. et al. (2021) 'Availability and accessibility of primary care for the remote, rural, and poor population of Indonesia', Frontiers in Public Health, 9.

World Bank (n.d.) Universal Health Coverage Overview. Available at: https://www.worldbank.org/en/topic/universalhealthcoverage (Accessed: 21 December 2024).

World Bank (2024) ‘World Bank country classifications by income level for 2024-2025’. Available at: https://blogs.worldbank.org/en/opendata/world-bank-country-classifications-by-income-level-for-2024-2025 (Accessed: 21 December 2024).

World Bank (2025) 'World Bank country and lending groups'. Available at: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups.

Zhao, C., Wang, C., Shen, C. and Wang, Q. (2018) ‘China’s achievements and challenges in improving health insurance coverage’, Drug Discovery & Therapy, 12(1), pp. 1–6.

Bahasa Abstract

Universal Health Coverage (UHC) bertujuan untuk memastikan bahwa semua individu memiliki akses ke layanan kesehatan esensial tanpa menghadapi kesulitan finansial. Jaminan Kesehatan Sosial (JKS) memiliki peran penting dalam mencapai tujuan ini, terutama di negara-negara berpenghasilan rendah dan menengah. Tinjauan sistematis ini mengeksplorasi peran sistem JKS dalam mendorong UHC di 14 negara Asia, dengan fokus pada akses layanan kesehatan, perlindungan finansial, dan kesetaraan. Pencarian komprehensif melalui PubMed, Scopus, dan ScienceDirect mengidentifikasi 768 artikel, dan setelah proses penyaringan berdasarkan pedoman PRISMA, 37 studi terpilih. Studi-studi yang dipilih mencakup negara-negara dengan berbagai model JKS di Asia. Hasil penelitian menunjukkan bahwa negara-negara berpenghasilan tinggi seperti Jepang, Korea Selatan, dan Singapura telah mencapai kemajuan yang signifikan menuju UHC. Namun, mereka masih menghadapi tantangan terkait populasi yang menua dan keberlanjutan finansial. Di Thailand, Skema Jaminan Kesehatan Universal telah berhasil mencapai cakupan yang hampir universal, sementara Malaysia dan Indonesia masih mengalami kesulitan dalam akses layanan kesehatan di daerah pedesaan dan perawatan khusus. Di negara-negara berpenghasilan menengah ke bawah seperti India, Vietnam, dan Bangladesh, perlindungan finansial telah menunjukkan peningkatan, tetapi masih terdapat kesenjangan dalam perawatan rawat jalan dan akses yang setara. Nepal dan Kamboja menghadapi hambatan besar akibat kendala ekonomi dan geografis. Tinjauan ini menegaskan peran penting JKS dalam mendorong UHC dan menyoroti perlunya reformasi kebijakan, inovasi pembiayaan, serta intervensi yang terarah untuk memperkuat sistem JKS dan meningkatkan akses layanan kesehatan yang setara bagi seluruh populasi di Asia.

Download

Plum Print visual indicator of research metrics
PlumX Metrics
  • Usage
    • Downloads: 103
    • Abstract Views: 88
see details

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.