Abstract : The medical insurance system has been designed to protect against catastrophic health expenditure (CHE) by reducing out-of-pocket health expenditures over the last few decades, but the protective effect has remained unknown. The purpose of this review was to examine the impacts of health insurance on CHE. The systematic review was carried out in accordance with the Cochrane Handbook and reported in accordance with PRISMA. From January 2000 to September 2022, we searched English literature databases such as PubMed, EMBASE, and Science Direct for empirical studies on the relationship between health insurance and CHE. Two reviewers were responsible for study selection, data extraction, and quality assessment. Meta-analysis and subgroup analysis were used to examine comparisons between articles with different types study design. A total of 710 citations were obtained, and finally 7 eligible studies with 37882 participants were included. The overall odds of CHE rate was lower (AOR= 0.41; 95% CI= 0.28-0.58; p< 0.0001) for people with health insurance compared with people without health insurance. To some extent, the existing health insurance plan has reduced the rate of CHE. More effort is required to control excessive medical demand and rising costs.