Health Financing Health Financing for Universal Health Coverage: A Comparative Narrative Review of Revenue Raising, Pooling, Strategic Purchasing, and Resilience Across Selected Health Systems

Abstract

Background : Health financing is the cornerstone of achieving Universal Health Coverage (UHC) and ensuring long-term health system resilience.

Objective: This narrative review aims to synthesize selected country experiences across diverse income settings and identify context-specific pathways for building inclusive and sustainable healthcare systems globally.

Design and Methodology: The review analyzes literature published between 2000 and 2026 using a functional health-financing framework encompassing revenue raising, risk pooling, and strategic purchasing. It compares tax-funded Beveridge models, Social Health Insurance (SHI) schemes, and fragmented multi-payer systems, including country-specific experiences such as Thailand’s Universal Coverage Scheme and Rwanda’s Community-Based Health Insurance.

Results: Tax-based systems generally prioritize equity, although their sustainability is often dependent on macroeconomic stability. Conversely, SHI models provide robust financial protection but face significant challenges in extending coverage to informal-sector populations. The findings indicate that systemic resilience—defined as the capacity to withstand macroeconomic shocks without increasing out-of-pocket (OOP) expenditure—depends on transitioning from passive funding to strategic, value-based purchasing and strengthening domestic resource mobilization.

Conclusion and Implications: No single health-financing model is universally applicable across different socioeconomic and institutional contexts. Inclusive and sustainable healthcare systems therefore require context-specific reforms that strengthen domestic resource mobilization, consolidate risk pooling, expand protection for informal-sector populations, and institutionalize strategic, value-based purchasing.