Factors influencing financial protection of the elderly within the framework of universal health coverage: A scoping review

The global increase in the elderly population, particularly in developing countries, has posed significant challenges to health systems and the financing of healthcare services. This study aimed to identify the factors influencing the financial protection of the elderly within the framework of universal health coverage. This study was conducted as a scoping review based on the Arksey and O’Malley framework. Relevant information was collected by searching keywords in databases including PubMed, Web of Science (WOS), ScienceDirect, Embase, Scopus, and the search engine Google Scholar, without any time limitations until February 8, 2025. EndNote X21 reference management software was used to organize the papers. Textual data were manually analyzed using content analysis methods. Out of 3,995 retrieved papers, 27 papers were selected for final analysis. The challenges related to the financial protection of the elderly in the health sector were categorized into eight main themes: contractual and legal challenges, financial and economic challenges, intersectoral communication and coordination challenges, infrastructural and managerial challenges, regulatory and executive challenges, cultural and social challenges, challenges related to service access and coverage, and administrative and bureaucratic challenges. Hybrid financing models based on taxation and insurance have provided better financial protection for the elderly and have significantly reduced catastrophic health expenditures (CHE) and out-of-pocket (OOP) payments. In countries reliant on direct OOP payments, elderly individuals are exposed to severe financial pressure. Countries with weak insurance coverage often resort to coping strategies such as borrowing and selling assets. The findings of this study indicate that financial protection methods and models for the elderly population, if properly designed and continuously monitored, can enhance the efficiency of health systems in protecting the elderly financially, improve equitable access of the elderly to healthcare services, and reduce overall costs for both the system and the elderly population. However, successfully implementing these models requires the development of clear policies, strengthened regulatory oversight, sustainable financing mechanisms, and improved intersectoral collaboration. Different countries must adapt financial protection models for their elderly populations according to their economic conditions, cultural contexts, and health policies, while drawing upon successful global experiences and formulating appropriate frameworks tailored to their local circumstances.