| DOI: 10.29090/psa.2026.02.26.9855 | Pharm Sci Asia 2026; 53(2), 230-244 |
The impact of supply-side and demand-side cost-containment strategies on universal health coverage outcomes in Southeast Asian National Health Insurance Schemes: A systematic reviewNila Vidila Utami1, Dwi Endarti2*, Susi Ari Kristina2
1 Master Program in Management Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
2
Department of Pharmaceutics, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
Southeast Asia's rapid growth of Universal Health Coverage (UHC) is increasingly hampered by growing healthcare costs and financial constraints. Although cost-containment instruments are widely implemented, their systemic trade-offs—particularly regarding health equity and service quality—remain poorly understood across the region's diverse health systems. This systematic review synthesizes empirical evidence on the effectiveness of supply-side and demand-side cost-containment instruments across five UHC outcome domains (financial protection, access, equity, quality, and efficiency) in Southeast Asian National Health Insurance schemes. Following PRISMA 2020 guidelines, we systematically searched Scopus and PubMed from inception to December 2025. Of 362 records, 21 empirical studies from five countries (Thailand, Indonesia, Vietnam, Philippines, Lao PDR) met inclusion criteria. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Evidence reveals a sharp divergence in policy performance. Synergistic strategic purchasing—exemplified by Thailand's integrated capitation, global budgets, and central procurement—achieved significant pro-poor equity (27–30% of subsidies concentrated in the poorest quintile) and 25% savings in pharmaceutical expenditures. Conversely, fragmented instruments in other settings triggered adverse provider behaviors, including cost-shifting to patients, induced utilization, and potential quality concerns. Even in relatively high-performing schemes, persistent inequities related to geography, gender, and chronic disease management remain unresolved. Cost-containment effectiveness depends fundamentally on governance maturity and policy integration, not technical design alone. To safeguard UHC sustainability, Southeast Asian policymakers should transition from fragmented cost-cutting toward data-driven, quality-linked strategic purchasing frameworks that actively monitor equity and outcomes.
Keyword:
Cost control; Universal Health Coverage; Health equity; Health financing; Southeast Asia
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