Global Health Coverage Improves, But Billions Still Face Financial Hardship, New Report Finds
A new report reveals significant strides in expanding health service coverage and reducing financial hardship related to healthcare costs globally, yet billions remain vulnerable, particularly those living in poverty. The UHC Global Monitoring Report 2025, jointly released by the World Health Organization (WHO) and the World Bank Group, underscores both the progress made and the urgent need for accelerated action to achieve universal health coverage (UHC) by 2030.
Progress Towards Universal Health Coverage
Since 2000, the world has witnessed a notable expansion in access to essential health services. The report, utilizing the Service Coverage Index (SCI), shows a rise from 54 to 71 points between 2000 and 2023. Simultaneously, the proportion of individuals experiencing financial hardship due to substantial out-of-pocket (OOP) health expenses decreased from 34% to 26% between 2000 and 2022.
However, this positive trend masks a stark reality: the poorest populations continue to shoulder the greatest burden of unaffordable healthcare. According to the report, 1.6 billion people have been pushed further into poverty due to health expenses. Overall, an estimated 4.6 billion people worldwide still lack access to essential health services, and 2.1 billion experience financial hardship accessing care, including those 1.6 billion living in poverty or driven deeper into it by medical costs.
“Universal health coverage is the ultimate expression of the right to health, but this report shows that for billions of people who cannot access or afford the health services they need, that right remains out of reach,” stated a senior official from the WHO. “In the context of severe cuts to international aid, now is the time for countries to invest in their health systems, to protect the health of their people and economies.”
The Cost of Care and its Disproportionate Impact
Financial hardship in health is defined as a household allocating more than 40% of its discretionary budget to OOP health expenses. The report highlights that the cost of medicines is a major contributor to this hardship, accounting for at least 55% of OOP health expenses in three-quarters of countries with available data. This burden is even more pronounced for those living in poverty, who dedicate a median of 60% of their OOP health spending to medications, diverting scarce resources from other essential needs.
While the impact of OOP health costs disproportionately affects poorer populations, it also impacts more affluent segments, particularly in middle-income countries. This suggests a growing financial strain on healthcare access across various income levels.
Projected Shortfalls and Emerging Trends
Without a significant acceleration in progress, achieving full-service coverage without financial hardship by 2030 appears increasingly unlikely. Projections indicate the global SCI will only reach 74 out of 100 by 2030, leaving nearly one in four people worldwide facing financial hardship at the end of the Sustainable Development Goals (SDG) era.
Despite a generally positive direction, the global progress rate has slowed since 2015, with only one-third of countries demonstrating improvement in both increasing health coverage and reducing financial hardship. While all WHO regions have improved service coverage, only half – Africa, South-East Asia, and the Western Pacific – have also reduced financial hardship. Low-income countries have achieved the fastest gains in both areas but continue to face the largest gaps.
The increase in health service coverage has been largely driven by advancements in infectious disease programs. Coverage for noncommunicable diseases (NCDs) has shown steady improvement, while gains in reproductive, maternal, newborn, and child health have been more modest. Improved sanitation has also played a supporting role in expanding service coverage. Inclusive economic growth, rising incomes, and stronger social protection mechanisms have contributed to poverty reduction and declines in financial hardship, particularly in low-income countries.
Rising Inequalities and Vulnerable Populations
Despite overall progress, inequalities in healthcare access are widening. In 2022, three out of four people in the poorest segment of the population faced financial hardship from health costs, compared to fewer than one in 25 among the wealthiest.
Women, individuals living in poverty, those in rural areas, and people with less education consistently report greater difficulty accessing essential health services. While the gap between women in the richest and poorest quintiles has slightly narrowed – from approximately 38 to 33 percentage points over the past decade – disparities remain significant. Even in high-performing regions like Europe, vulnerable groups, including the poorest and people with disabilities, continue to experience higher unmet health needs.
These findings likely underestimate the true extent of health inequalities, as data sources often exclude the most vulnerable populations, such as displaced individuals and those living in informal settlements.
A Call to Action for 2030
Achieving the UHC goal by 2030 is crucial for realizing the human right to health. With only five years remaining on the SDG agenda, urgent action is needed. The report emphasizes the critical role of political commitment and calls for action in six core areas:
- Ensuring essential healthcare is free at the point of care for people living in poverty and vulnerable situations.
- Expanding public investments in health systems.
- Addressing high out-of-pocket spending on medicines.
- Accelerating access to essential NCD services.
- Strengthening primary healthcare to promote equity and efficiency.
- Adopting multisectoral approaches, recognizing that health determinants extend beyond the health sector.
The UHC Global Monitoring Report 2025 represents the first round of UHC tracking to incorporate revised SDG indicators for health service coverage and financial hardship, introduced in 2025. The report was presented at the UHC High-Level Forum in Tokyo, Japan, alongside the launch of the UHC Knowledge Hub, which will offer capacity-building programs for Ministries of Health and Finance to support health financing reforms.
WHO, the World Bank Group, UHC2030, and the Joint Learning Network for Universal Health Coverage will host a technical webinar on December 8, 2025, to discuss the report’s findings. You can join the webinar through this link: https://example.com/webinar (Passcode: .W1MJT=@r3).
