<![CDATA[The increasing complexity of healthcare systems has intensified challenges in hospital financial management, particularly within Islamic healthcare institutions. Muhammadiyah hospitals are expected to maintain financial efficiency and sustainability while adhering to Islamic ethical values and fiqh principles. Similarly, sharia health insurance requires governance founded on justice, transparency, and mutual assistance (ta'awun). However, existing studies addressing hospital financial governance and sharia health insurance from Muhammadiyah perspectives remain fragmented. This study aimed to synthesize the ethical and fiqh principles underlying hospital financial management and sharia health insurance within Muhammadiyah healthcare through a systematic literature review. A Systematic Literature Review (SLR) was conducted following the PRISMA 2020 guidelines. Literature searches were performed in Scopus, PubMed, Google Scholar, Garuda, and DOAJ databases covering publications from 2015 to 2026. Studies meeting predefined inclusion and exclusion criteria were selected and analyzed using thematic synthesis. A total of 32 studies were included in the final review. Five major themes emerged: ethical principles of financial governance, fiqh-based financing mechanisms, implementation of takaful, Muhammadiyah perspectives on BPJS Health, and the integration of maqashid al-shariah into healthcare financing systems. The findings identified five key foundations of Muhammadiyah hospital financial governance: justice (‘adl), transparency, accountability (amanah), public benefit (maslahah), and avoidance of prohibited financial elements such as riba, gharar, and risywah. Sharia health insurance was consistently viewed as a cooperative mechanism based on tabarru’ and risk-sharing principles. Muhammadiyah also supports participation in Indonesia’s National Health Insurance system (BPJS Kesehatan) provided it upholds justice, transparency, and social welfare. These findings suggest that integrating sharia-based financial ethics into hospital governance may contribute to sustainable, equitable, and socially responsible healthcare systems]]>
