Impact of the Cooperative Health Insurance System in Saudi Arabia on Universal Health Coverage-A Systematic Literature Review

Background: This systematic review assesses the role of the Cooperative Health Insurance System (CHIS) in achieving Universal Health Coverage (UHC) in Saudi Arabia's evolving healthcare system by consolidating and analyzing findings from diverse studies to provide a comprehensive overview of CHIS's impact and also identifies contextual challenges and practical insights that can inform similar reforms globally. Methods: We report results following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following six databases were searched for relevant studies: PubMed, Scopus, CINAHL, Business Source Complete, APA PsycINFO, and SocIndex. The review protocol was registered with PROSPERO. Inclusion criteria focused on studies examining the impact of CHIS on the UHC dimensions based on the following themes: population covered, affordability, quality, efficiency, access, services covered, and financial coverage. The initial search identified 1316 publications. Results: A total of 30 studies met the inclusion criteria. Our synthesis indicates that CHIS has significantly improved healthcare access and quality, particularly in the private sector. CHIS was also associated with increased healthcare efficiency through standardized benefit packages and reduced out-of-pocket expenditures. However, these studies noted challenges such as rising insurance premiums, infrastructural deficiencies, and cultural barriers. Conclusions: CHIS is integral to Saudi Arabia's healthcare reform, substantially contributing to UHC's objectives. Despite notable advances, continuous efforts are needed to address existing challenges and expand coverage. The findings suggest that enhanced government support and public awareness are crucial for advancing UHC goals in Saudi Arabia.