This systematic review examines the challenges and strategies for sustaining Universal Health Coverage (UHC) in Malaysia, with a focus on the country’s health financing framework. Despite Malaysia’s significant progress in providing affordable public healthcare through a tax-funded system, rising healthcare costs, underfunding, and increasing out-of-pocket (OOP) payments threaten long-term sustainability. Using the PRISMA framework, 22 studies published between 2010 and 2025 were analysed, encompassing policy reviews, systematic reviews, and mixed-method studies. The findings reveal key challenges such as fiscal constraints, demographic shifts, inequities in rural access, and a fragmented public–private sector. Comparative insights from regional models, including Thailand and Singapore, highlight the importance of diversified funding sources, strategic purchasing, and stronger governance. Policy recommendations include broadening revenue streams through sin taxes and social health insurance, enhancing digital health adoption, improving preventive and primary care, and fostering public–private partnerships. The review highlights the urgency for Malaysia to implement progressive, evidence-based reforms to build a healthcare system that is fair, financially protective, and resilient for all. Keywords: healthcare funding, healthcare financing, health finance, Universal Health Coverage, UHC, access to care, private health insurance, social health insurance, Malaysia