When the United Nations laid out the Sustainable Development Goals (SDGs) in 2015, universal health coverage (UHC) was one of the targets agreed upon by the nations of the world. Meeting UHC targets would ensure that all people would have access to quality health services they require without financial hardship. However, tracking statistics show that this target is far from being met. In 2023, WHO reported that 4.6 billion people worldwide still lacked access to essential health services, and 2.1 billion people faced health-related financial hardship in 2022. WHO predicted that by 2030, the endpoint of the SDGs, 1 in 4 people globally will continue to face health-related financial hardship.

Out-of-pocket (OOP) health spending is the payment for healthcare or health services out of the household budget, meaning from one’s own income, savings or loans. This can include healthcare consultations such as clinic or hospital visits, diagnostic services and medicine purchase that are not covered by insurance, taxes or reimbursements.

OOP spending heavily affects the poor, whose household discretionary budgets are closely matched to their income. This means that if someone in the household faces an emergency that calls for a larger proportion of the budget, they would have to cut their expenses in other basic needs. An example is when a family member falls ill and requires medication or medical care. Vulnerable populations face the potential of being pushed into poverty or being further impoverished from OOP spending. This has been estimated to affect 1.3 billion people.

The statistics show that while financial hardship in health affects a higher proportion of the poor or those already living in poverty, it also affects a growing population of people with higher income worldwide. With limited allocation of funding to health spending, middle-income countries rely on OOP spending to expand health service coverage. Their average OOP spending per capita was notably 4% higher than before the pandemic.

According to WHO global health expenditure data, health expenditure worldwide has more than doubled from year 2000 to 2022, growing at a faster rate than global GDP. The pandemic saw a sharp increase in health spending, though this varied widely between different-income countries, considering the mobility of funding and provision of external aid. Recent large funding cuts have disrupted the delivery essential health services in many countries, and it remains to be seen how this will affect the future of healthcare in the long term.

We introduce this blog series as part of a collaboration project between SDG 1: No Poverty and SDG 3: Good Health and Well-Being working groups at Springer Nature. It seeks to explore the inequalities linked to unmet health needs and increase awareness of the issues in the pursuit of universal health coverage: is the future of healthcare affordable and sustainable for all?

Sources and further reading:

World Health Organization. (2025). Tracking universal health coverage: 2025 global monitoring report. https://www.who.int/publications/i/item/9789240117808

World Health Organization. (2025). Tracking universal health coverage: 2023 global monitoring report. https://www.who.int/publications/i/item/9789240080379

World Health Organization. (2024). Global spending on health: Emerging from the pandemic. https://www.who.int/teams/health-financing-and-economics/global-spending-on-health-2024

World Health Organization. (2026). Health inequality data repository. https://www.who.int/data/inequality-monitor/data

Related Sustainable Development Goals:

SDG 1: No Poverty
SDG 3: Good Health and Well-being
SDG 3.8: Universal health coverage (UHC)
SDG 3.8.2: Financial hardship in health

Keywords: health inequality, healthcare, universal health coverage, out-of-pocket, global health expenditure