Two billion people also face severe financial hardship when paying out-of-pocket for the health services
Over four and a half billion people, ranging from approximately 14–87% of the population at the country level, were not fully covered by essential health services in 2021, a report jointly published by the World Health Organization (WHO) and the World Bank has revealed.
The 2023 Universal Health Coverage (UHC) Global Monitoring Report, released just ahead of the 78th United Nations General Assembly, also reveals that two billion people face severe financial hardship when paying out-of-pocket for the health services.
The proportion of the population not covered by essential health services decreased by about 15% between 2000 and 2021, with minimal progress made after 2015.
“The fact that so many people cannot benefit from affordable, quality, essential health services not only puts their own health at risk, it also puts the stability of communities, societies and economies at risk. We urgently need stronger political will, more aggressive investments in health, and a decisive shift to transform health systems based on primary health care,” he added.
The report found that over the past two decades less than a third of countries have improved health service coverage and reduced catastrophic out-of-pocket health spending. Moreover, most countries for which data are available on both UHC dimensions (96 out of 138) are off-track in either service coverage, financial protection, or both.
“We know that achieving Universal Health Coverage is a critical step in helping people escape and stay out of poverty, yet there continues to be increased financial hardship, especially for the poorest and most vulnerable people,” Vice President for Human Development, World Bank, Mamta Murthi, said. “This report paints a dire picture, but also offers evidence on ways to prioritize health in government budgets and strengthen health systems for greater equity in both the delivery of essential quality health services and financial protection.”
The consistent rise in out-of-pocket health expenditure, when it surpasses 10% of a household’s budget, is a cause for growing concern. More than one billion people, about 14% of the global population, experienced such large out-of-pocket payments relative to their budgets. But even small expenditures in absolute terms can be devastating for low-income families; approximately 1.3 billion individuals were pushed or further pushed into poverty by such payments, including 300 million people who were already living in extreme poverty.
Out-of-pocket health payments can also cause individuals to forego essential care and force families to choose between paying for a visit to the doctor, buying food and water, or sending their children to school. Such trade-offs can spell the difference between the early treatment of a preventable disease and, at a later stage, suffering severe illness or even death. Addressing this problem requires progressive health financing policies that exempt those with limited ability to pay for health services.