# Determinants of private health insurance uptake and its association with healthcare utilization in Gulf Cooperation Council countries: a systematic review

## TL;DR

This review examines how private health insurance is adopted and affects healthcare use in Gulf countries with mixed public and private systems.

## Contribution

The study identifies how policy shifts and socioeconomic factors influence private insurance enrollment and healthcare access in GCC countries.

## Key findings

- Private health insurance uptake is linked to being male, married, highly educated, employed with high income, and having chronic diseases.
- Private health insurance is associated with increased use of routine check-ups, preventive services, and prescribed medicines.
- Policy reforms and socioeconomic factors interact to shape access patterns under mixed insurance systems in GCC countries.

## Abstract

All Gulf Cooperation Council (GCC) countries have a multi-payer healthcare system that comprises governmental health coverage (GHC), funded by the government, and private health insurance (PHI), mainly sponsored by employers and purchased by individuals. Both are expected to influence healthcare utilization and contribute to system efficiency and patient well-being. This systematic review explored the determinants of PHI uptake and its association with healthcare service utilization in the presence of GHC in GCC countries. We systematically searched CINAHL, PubMed, Scopus, Web of Science, and Cochrane Library for peer-reviewed studies published between January 2012 and October 2022. Study quality was assessed using the Critical Appraisal Skills Programme (CASP) checklists for both quantitative and qualitative studies, following PRISMA guidelines. Twenty-six studies met the inclusion criteria. Determinants of PHI uptake were mapped to Andersen’s Behavioral Model of Health Services Use (BMHSU) and categorized into (1) predisposing factors (sex, age, marital status, and education), (2) enabling factors (employment/income and health system-related factors such as access and perceived service quality), and (3) need factors (health status, including chronic noncommunicable diseases). PHI uptake was positively associated with being male, married, highly educated, employed with a high income, and having chronic diseases. PHI was positively associated with healthcare utilization, particularly routine check-ups, preventive services, and the use of prescribed medicines. In GCC countries, PHI uptake is influenced by sociodemographic and socioeconomic characteristics, health status, and perceived service quality. PHI is also associated with higher healthcare utilization, underlining the need for evidence-informed policies that enhance equity and expand coverage.

Main finding: Private health insurance uptake across Gulf Cooperation Council countries was influenced by sociodemographic and socioeconomic characteristics, health status, and the quality of services. Additionally, private health insurance was likely to be associated with higher utilization of healthcare services.Added knowledge: This systematic review identifies how shifts in health policy across Gulf Cooperation Council countries, particularly the move from universal public coverage toward mixed systems combining governmental and mandatory private insurance which have redefined the determinants of private health insurance enrollment and healthcare utilization. It highlights how socioeconomic characteristics and policy reforms interact to shape access patterns under differing insurance schemes.Global health impact: The findings can support policymakers in developing equitable and sustainable health financing reforms toward universal health coverage.

Main finding: Private health insurance uptake across Gulf Cooperation Council countries was influenced by sociodemographic and socioeconomic characteristics, health status, and the quality of services. Additionally, private health insurance was likely to be associated with higher utilization of healthcare services.

Added knowledge: This systematic review identifies how shifts in health policy across Gulf Cooperation Council countries, particularly the move from universal public coverage toward mixed systems combining governmental and mandatory private insurance which have redefined the determinants of private health insurance enrollment and healthcare utilization. It highlights how socioeconomic characteristics and policy reforms interact to shape access patterns under differing insurance schemes.

Global health impact: The findings can support policymakers in developing equitable and sustainable health financing reforms toward universal health coverage.