Presentation (CTI)

OBJECTIVES: From 2015 to 2021, household out-of-pocket spending as a share of current health expenditure in Asia-Pacific countries decreased by 3-5%. However, it remained high in low- and middle-income countries (43%), upper-middle-income countries (24%), and less so in high-income countries (16%). Concurrently, voluntary payment schemes remained relatively stable, contributing an average of 10% to current health expenditure with minimal fluctuations between 0.5-1% across countries of various income levels. Given the challenges of limited public budgets, population ageing and demand for new technologies, there is an urgent need to promote voluntary contributions with risk pooling such as voluntary health insurance plans. We aimed to systematically identify key attributes for consumers when choosing voluntary health insurance plans and their relative importance of these attributes.
METHODS: We conducted a systematic review to determine attributes that consumers prioritize when considering voluntary health insurance scheme. We searched publications from January 2005 to December 2025 across four sources (PubMed, Scopus, CINAHL, PsycINFO, and EMBASE). We assessed the selected qualitative studies using CASP checklist. The study methodology was pre-registered with PROSPERO (CRD420250640680).
RESULTS: We reviewed 1,778 studies and identified 9 relevant studies that met the inclusion criteria. These covered literature reviews, quantitative methods (such as choice experiments, conjoint analysis, cross-sectional studies), qualitative methods (such as focus group interviews), and mixed methods. Studies were conducted in various locations, including China, India, United States, Uganda, Chile, Japan, Laos and Australia. Number of participants ranged from 29 to 56,990, with the majority being adults and permanent residents of the countries/regions. Common attributes identified across the studies were insurance premiums, benefit packages, reimbursement for hospitalization and healthcare providers covered.
CONCLUSIONS: By focusing on the identified set of attributes, insurance providers and policymakers can develop more consumer-centered plans, potentially increasing adoption rates and improving overall consumer satisfaction with voluntary health insurance options.