Effects of health insurance on economic burden and health service utilization among people with noncommunicable diseases in low- and middle-income countries: a systematic review

Noncommunicable diseases (NCDs) are leading causes of mortality and impose substantial financial burdens on households. Health insurance is intended to mitigate these economic burdens and increase health service utilization among people with NCDs. This study aims to investigate the impacts of health insurance on economic protection and health service utilization among people with NCDs in low- and middle-income countries. A systematic search of the relevant articles was conducted in PubMed, Scopus, and Embase in accordance with PRISMA guidelines. The search strategy was based on keywords representing the population (noncommunicable diseases), exposure (health insurance), and outcomes (economic burden and health service utilization). Data were synthesized according to NCD type and reported outcomes. Of the 3,992 articles screened, 15 met the inclusion criteria. Socioeconomic status was the most frequently identified determinant of NCD-related economic burden, alongside health service utilization, multiple morbidities, employment status, family size, and education. Health insurance was strongly associated with increased service utilization, while multiple morbidities, socioeconomic status, physician access, and education also influenced care use. The impact of insurance on financial burden was mixed: 7 of 10 studies found no significant reduction, whereas all studies reported increased service utilization among insured individuals. Health insurance was associated with increased health service utilization among people with NCDs, but its protective effect against economic burden remains inconclusive. Increased utilization was frequently linked to higher healthcare payments due to limited benefit coverage. Strengthening insurance design and assessing utilization pathways are essential to improve financial protection.