Transforming student health insurance with blockchain: a systematic review of efficiency, access, and implementation barriers

OBJECTIVE: To systematically review studies examining blockchain-powered architecture, smart contract, operational efficiency, data governance, and challenges to implementation within the context of student and university health insurance networks. METHODS: According to the PRISMA 2020 guidelines, Scopus, Web of Science, and PubMed databases were searched for articles published from January 2019 to December 2025. The searches yielded 957 records from the databases and an additional 12 records via citation searches. Of the remaining 478 articles, 18 studies were selected based on their relevance to the topic. The heterogeneous design, blockchain architecture, control groups, and outcomes precluded the use of meta-analysis. RESULTS: The domains covered in the included studies were student health records, claims processing automation, EHR interoperability, fraud detection and transparency, and implementation challenges. The use of blockchain technology was associated with an improvement in terms of automation of the claims process, document provenance, privacy-preserving data access control, fraud detection, and administrative efficiency. However, the quantitative findings were inconsistent and should be considered operational descriptions and not pooled results or cost-effectiveness findings. CONCLUSION: There is preliminary evidence that blockchain may help students and universities with their health insurance programs, but further pilot testing, longitudinal research, cost-benefit analysis, and equitable governance are needed prior to widespread application.