Despite two decades of global progress in expanding health services, an estimated 1.6 billion people were pushed into or deeper into poverty by health expenses and overall, 4.6 billion people still lack access to essential services while 2.1 billion face financial hardship when seeking care, a new joint global report has said.
Prepared by the World Health Organization (WHO) and the World Bank, the report has warned that the poorest households continue to be pushed further into poverty due to rising out-of-pocket health spending.
It said since 2000, most countries have improved both health service coverage and protection from catastrophic medical costs. These two indicators form the backbone of Universal Health Coverage (UHC), the global commitment that all people should be able to access essential care without financial hardship by 2030.
The UHC Global Monitoring Report 2025 shows that the Service Coverage Index (SCI) rose from 54 to 71 points between 2000 and 2023. Financial hardship due to large or impoverishing medical bills declined from 34% to 26% over the same period.
But for a large section of poor people financial hardship further pushed them deeper into poverty as health-care services remained out of reach, escalating their out of pocket expenditure.
A household is considered to face financial hardship when more than 40% of its discretionary budget goes toward medical bills. Medicines remain the biggest burden: in nearly three-quarters of countries, over 55% of all out-of-pocket payments are on drugs alone. Among the poorest, this share rises to a median 60%, often forcing families to cut back on food, housing or education.
While the impact is most severe among low-income households, middle-income countries are also witnessing rising pressure on better-off families, many of whom spend a growing portion of their earnings on chronic disease care and medicines, noted the report.
At the current pace, the world is unlikely to meet its 2030 target. The global SCI is projected to reach only 74 out of 100 by the end of the Sustainable Development Goals period, and nearly a quarter of the global population will still face financial distress over health costs.
The report highlights encouraging progress in low-income countries, which have recorded the fastest improvements in both service coverage and financial protection, though they continue to face the largest gaps. Gains have been driven primarily by infectious disease programmes, with non-communicable disease services improving steadily and maternal and child health services advancing more modestly.
Improved sanitation, higher incomes and expanded social protection have supported these trends. Yet, health spending itself has increasingly become a driver of poverty, especially among marginalised groups.
Inequalities, the report warns, are widening. In 2022, three in four people in the poorest population segment faced financial hardship due to health costs, compared with fewer than one in 25 among the richest. Women, rural communities, people with disabilities and those with less education reported greater difficulty accessing essential services.
Even in high-performing regions such as Europe, unmet health needs remain disproportionately high among vulnerable groups. The report notes that exclusion of displaced communities and informal settlements likely means the actual scale of inequality is far greater.
With just five years left to achieve UHC by 2030, the report has called for urgent action in six areas. “Making essential services free at the point of care for the poor; boosting public health investments; reducing out-of-pocket spending on medicines; accelerating access to NCD services; strengthening primary health care; and adopting multisectoral approaches that recognise the broad determinants of health,” is needed, said the report.
"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,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General. “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. WHO is supporting them to do that.”
