Financial barriers can affect timely access to maternal health
services. Health insurance can influence the use and quality of these
services and potentially improve maternal and neonatal health outcomes.
We conducted a systematic review of the evidence on health insurance
and its effects on the use and provision of maternal health services
and on maternal and neonatal health outcomes in middle- and low-income
countries. Studies were identified through a literature search in key
databases and consultation with experts in healthcare financing and
maternal health. Twenty-nine articles met the review criteria of
focusing on health insurance and its effect on the use or quality of
maternal health services, or maternal and neonatal health outcomes.
Sixteen studies assessed demand-side effects of insurance, eight
focused on supply-side effects, and the remainder addressed both.
Geographically, the studies provided evidence from sub-Saharan Africa
(n=11), Asia (n=9), Latin America (n=8), and Turkey. The studies
included examples from national or social insurance schemes (n=7),
government-run public health insurance schemes (n=4), community-based
health insurance schemes (n=11), and private insurance (n=3). Half of
the studies used econometric analyses while the remaining provided
descriptive statistics or qualitative results. There is relatively
consistent evidence that health insurance is positively correlated with
the use of maternal health services. Only four studies used methods
that can establish this causal relationship. Six studies presented
suggestive evidence of overprovision of caesarean sections in response
to providers\u2019 payment incentives through health insurance. Few
studies focused on the relationship between health insurance and the
quality of maternal health services or maternal and neonatal health
outcomes. The available evidence on the quality and health outcomes is
inconclusive, given the differences in measurement, contradictory
findings, and statistical limitations. Consistent with economic
theories, the studies identified a positive relationship between health
insurance and the use of maternal health services. However, more
rigorous causal methods are needed to identify the extent to which the
use of these services increases among the insured. Better measurement
of quality and the use of cross-country analyses would solidify the
evidence on the impact of insurance on the quality of maternal health
services and maternal and neonatal health outcomes