Health insurance service model on the basis of patient-centered care: a scoping review


  • Moh Ali Imron Faculty of Health Sciences, Universitas Aisyiyah Yogyakarta, Indonesia
  • Andari Wuri Astuti Universitas Aisyiyah Yogyakarta, Indonesia
  • Hilmi Zadah Faidullah Faculty of Health Sciences, Universitas Aisyiyah Yogyakarta, Indonesia
  • Wantonoro Faculty of Health Sciences, Universitas Aisyiyah Yogyakarta, Indonesia
  • Siti Fatimah Universitas Muhammadiyah Banjarmasin, Indonesia
  • Khaterina Kristina Manurung BPJS Kesehatan, Indonesia
  • Maya Febriyanti BPJS Kesehatan, Indonesia
  • Dedy Revelino Siregar BPJS Kesehatan, Indonesia
  • Wan Aisyah Baros BPJS Kesehatan, Indonesia



patient-centered care;


Health insurance provides access to every color of the country to get access to health services in the form of promotive, preventive, curative, and rehabilitative efforts at affordable costs. Integrated health services that focus on patient needs (patient-centered care) will increase the active role of families and communities in making decisions related to health services to be provided and are often associated with health financing and insurance used. This Scoping review aims to explore and map the scientific evidence related to the health insurance model in patient-centered care-based health services. This study uses Arkshey & O'Malley Framework and PRISMA-ScR Checklist. In the identification of articles used using PubMed, EBSCO, ProQuest, Wiley Online Library, and Grey supporting literature such as Google Scholar and appropriate databases. The article inclusion criteria used in the search are primary articles in 2012-2022, articles from relevant Gray literature and databases, scientific articles in English and/ or Indonesian, and scientific articles that focus on the health care insurance model and patient-centered care-based health services. While the exclusion criteria used are articles in the form of guidelines, standard operating procedures, opinion papers, reviews, commentaries, research articles that do not use English and Indonesian, and research articles that focus on medicine-centered care are not included in this review. The keywords used are patient-centered care and health insurance. Assessment of Article quality using the Critical Appraisal Skills Program (CASP) and Joanna Bridge Institute Tools (JBI). A total of 6,388 articles were selected and 14 articles were reviewed. Research articles were reviewed from 8 countries with 12 articles using quantitative research design and 2 articles using qualitative research design. From the review article, the author identified 2 main themes, namely the use of health insurance and the application of patient-centered care. Patient satisfaction among Health Insurance users is higher than patients who do not use health insurance because health insurance provides financial protection for health services. The use of health insurance based on patient-centered care is expected to provide positive benefits to health services such as improving patient healing, reducing unnecessary actions/ care, and reducing the length of hospital treatment so that it is expected to reduce the financing made by patients and health insurance used.

Author Biography

Andari Wuri Astuti, Universitas Aisyiyah Yogyakarta

Google Scholar URL Scopus ID 57211968612


Assembly, W. H. (2015). Social health insurance: sustainable health financing, universal coverage and social health insurance: report by the Secretariat. In World Health Organization, April, 4. (p. 58).

Badu, Agyei-Baffour, Acheampong, O., Opoku, & Addai-Donkor. (2019). Perceived satisfaction with health services under National Health Insurance Scheme: Clients’ perspectives. The International Journal of Health Planning and Management, 34(1), e964–e975.

Badu, E., Agyei-Baffour, P., Ofori Acheampong, I., Opoku, M. P., & Addai-Donkor, K. (2019). Perceived satisfaction with health services under National Health Insurance Scheme: Clients’ perspectives. The International Journal of Health Planning and Management, 34(1), e964–e975.

Barry, M. J., & Edgman-Levitan, S. (2012). Shared Decision Making — The Pinnacle of Patient-Centered Care. New England Journal of Medicine, 366(9), 780–781.

Berkowitz, S. A., Gold, R., Domino, M. E., & Basu, S. (2021). Health insurance coverage and self-employment. Health Services Research, 56(2), 247–255.

Calvo, R., Jablonska-Bayro, J. M., & Waters, M. C. (2017). Obamacare in action: how access to the health care system contributes to immigrants’ sense of belonging. Journal of Ethnic & Migration Studies, 43(12), 2020–2036.

Dake, F. A. A. (2018). Examining equity in health insurance coverage: an analysis of Ghana’s National Health Insurance Scheme. International Journal for Equity in Health, 17.

Doshi, R. S., Bleich, S. N., & Gudzune, K. A. (2017). Health Professionals’ perceptions of insurance coverage for weight loss services. Obesity Science & Practice, 3(4), 384–389.

Epstein, Fiscella, Lesser, & Stange. (2019). Analysis & commentary: Why the nation needs a policy push on patient-centered health care. Health Affairs, 29(8), 1489–1495.

Fulpagare, P. H., Saraswat, A., Dinachandra, K., Surani, N., Parhi, R. N., Bhattacharjee, S., Somya, S., Purty, A., Mohapatra, B., Kejrewal, N., Agrawal, N., Bhatia, V., Ruikar, M., Gope, R. K., Murira, Z., De Wagt, A., & Sethi, V. (2019). Antenatal Care Service Utilization Among Adolescent Pregnant Women–Evidence From Swabhimaan Programme in India. Frontiers in Public Health, 7(December).

Han, X., Call, K. T., Pintor, J. K., Alarcon-Espinoza, G., & Simon, A. B. (2015). Reports of Insurance-Based Discrimination in Health Care and Its Association With Access to Care. American Journal of Public Health, 105, S517–S525.

Hower, K. I., Vennedey, V., Hillen, H. A., Kuntz, L., Stock, S., Pfaff, H., & Ansmann, L. (2019). Implementation of patient-centred care: Which organisational determinants matter from decision maker’s perspective? Results from a qualitative interview study across various health and social care organisations. BMJ Open, 9(4), 1–14.

Hsu, N.-C., Chun-Che, H., Wei-Chun, C., & Chong-Jen, Y. (2019). Impact of patient-centred and family-centred care meetings on intensive care and resource utilisation in patients with terminal illness: a single-centre retrospective observational study in Taiwan. BMJ Open, 9(2).

Kamra, V., Singh, H., & Kumar De, K. (2016). Factors affecting patient satisfaction: an exploratory study for quality management in the health-care sector. Total Quality Management & Business Excellence, 27(9/10), 1013–1027.

Karsnitz, D. B. (2013). Puerperal infections of the genital tract: A clinical review. Journal of Midwifery and Women’s Health, 58(6), 632–642.

Kennedy, A. J., Bakalov, V., Reyes-Uribe, L., Kensler, C., Connor, S. E., Benson, M., Bui, T., & Radomski, T. R. (2020). Free Clinic Patients’ Perceptions and Barriers to Applying for Health Insurance After Implementation of the Affordable Care Act. Journal of Community Health, 45(3), 492–500.

Kuipers, S. J., Cramm, J. M., & Nieboer, A. P. (2019). The importance of patient-centered care and co-creation of care for satisfaction with care and physical and social well-being of patients with multi-morbidity in the primary care setting. BMC Health Services Research, 19(1), 1–9.

Levac, D., Colquhoun, H., & O’Brien, K. K. (2010). Scoping studies: Advancing the methodology. Implementation Science, 5(1).

Lipton, B. J. (2020). Association between Health Insurance and Health among Adults with Diabetes: Evidence from Medicare. Journal of the American Geriatrics Society, 68(2), 388–394.

Liu, X., Tang, S., Yu, B., Phuong, N. K., Yan, F., Thien, D. D., & Tolhurst, R. (2012). Can rural health insurance improve equity in health care utilization? a comparison between China and Vietnam. International Journal for Equity in Health, 11(1), 10.

Mead, Wang, Cleary, Arem, & Pratt-Chapman. (2021). Defining a patient-centered approach to cancer survivorship care: development of the patient centered survivorship care index (PC-SCI). BMC Health Services Research, 21(1), 1–14.

Mobley, E. M., Kim, S. E., Cousineau, M., Tsui, J., Miller, K. A., Tobin, J., Freyer, D. R., & Milam, J. E. (2022). Insurance coverage change and survivorship care among young adult survivors of childhood cancer. Health Services Research, 57(1), 159–171.

Moore, L., Britten, N., Lydahl, D., Naldemirci, Ö., Elam, M., & Wolf, A. (2017). Barriers and facilitators to the implementation of person-centred care in different healthcare contexts. Scandinavian Journal of Caring Sciences, 31(4), 662–673.

Myint, C.-Y., Pavlova, M., & Groot, W. (2019). Health insurance in Myanmar: Knowledge, perceptions, and preferences of Social Security Scheme members and general adult population. The International Journal of Health Planning and Management, 34(1), 346–369.

National Department of Health. (2019). National Health Insurance Bill [B 11-2019] (Issue 42598).

Nilsson, M., From, I., & Lindwall, L. (2019). The significance of patient participation in nursing care – a concept analysis. Scandinavian Journal of Caring Sciences, 33(1), 244–251.

Pearson, W. S., Cramer, R., Tao, G., Leichliter, J. S., Gift, T. L., & Hoover, K. W. (2016). Willingness to Use Health Insurance at a Sexually Transmitted Disease Clinic: A Survey of Patients at 21 US Clinics. American Journal of Public Health, 106(8), 1511–1513.

Peters, Godfrey, McInerney, Munn, Trico, & Khalil. (2020). Chapter 11: Scoping Reviews (2020 version). JBI Manual for Evidence Synthesis.

Pham, M. T., Rajić, A., Greig, J. D., Sargeant, J. M., Papadopoulos, A., & Mcewen, S. A. (2014). A scoping review of scoping reviews: Advancing the approach and enhancing the consistency. Research Synthesis Methods, 5(4), 371–385.

Pirhonen, L., Gyllensten, H., Fors, A., & Bolin, K. (2020). Modelling the cost-effectiveness of person-centred care for patients with acute coronary syndrome. European Journal of Health Economics, 21(9), 1317–1327.

Sessions, K., Hassan, A., McLeod, T. G., & Wieland, M. L. (2018). Health Insurance Status and Eligibility Among Patients who Seek Healthcare at a Free Clinic in the Affordable Care Act Era. Journal of Community Health, 43(2), 263–267.

Socías, E., Shoveller, Bean, Nguyen, Montaner, & Shannon. (2016). Universal Coverage without Universal Access: Institutional Barriers to Health Care among Women Sex Workers in Vancouver, Canada. PLoS ONE, 11(5), 1–16.

Stewart, Ryan, & Bodea. (2017). Is patient-centred care associated with lower diagnostic costs? Healthcare Policy, 6(4), 27–31.

Tricco, Lillie, Zarin, O’Brien, Colquhoun, Levac, & Moher. (2018). PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Annals of Internal Medicine, 169(7), 467–473.

UNAIDS. (2018). UNAIDS Data 2018. 1–376.

Vennedey, V., Hower, K. I., Hillen, H., Ansmann, L., Kuntz, L., & Stock, S. (2020). Patients’ perspectives of facilitators and barriers to patient-centred care: insights from qualitative patient interviews. BMJ Open, 10(5).

Vian, T., Feeley, F. G., Domente, S., Negruta, A., Matei, A., & Habicht, J. (2015). Barriers to universal health coverage in Republic of Moldova: A policy analysis of formal and informal out-of-pocket payments. BMC Health Services Research, 15(1), 1–16.

WHO. (2021). Universal Health Coverage (UHC). WHO.

Wittenberg-Lyles, E., Oliver, D. P., Demiris, G., Burt, S., & Regehr, K. (2010). Inviting the absent members: Examining how caregivers participation affects hospice team communication. Palliative Medicine, 24(2), 192–195.

Zisman-Ilani, Y., Obeidat, R., Fang, L., Hsieh, S., & Berger, Z. (2020). Shared Decision Making and Patient-Centered Care in Israel, Jordan, and the United States: Exploratory and Comparative Survey Study of Physician Perceptions. JMIR Formative Research, 4(8).




How to Cite

Imron, M. A., Astuti, A. W., Faidullah, H. Z., Wantonoro, Fatimah, S., Manurung, K. K., … Baros, W. A. (2024). Health insurance service model on the basis of patient-centered care: a scoping review. Journal of Health Technology Assessment in Midwifery, 7(1), 11–25.




Citation Check

Similar Articles

1 2 > >> 

You may also start an advanced similarity search for this article.