“Ensuring equitable access is critical for high-performing health systems and more inclusive societies. Population coverage – measured by the share of the population eligible for a core set of services and those satisfied with the availability of quality healthcare – offers an initial assessment of access to care. The proportion of spending covered by prepayment schemes gives further insight into financial protection. The share of populations reporting unmet needs for medical care offers a measure of effective service coverage. Figure 1.4 presents a snapshot of access to care across OECD countries, and Table 1.4 provides more detailed country comparisons.
“In terms of the share of the population eligible for coverage, most OECD countries have achieved universal (or near-universal) coverage for a core set of services. However, in Mexico, population coverage was 72% in 2021, and coverage was below 95% in a further five countries (Costa Rica, the United States, Poland, Chile and Colombia).
“Satisfaction with the availability of quality health services offers further insight into effective coverage. On average across OECD countries, 67% of people were satisfied with the availability of quality health services where they live in 2020. Citizens in Switzerland and Belgium were most likely to be satisfied (90% or more), whereas fewer than 50% of citizens were satisfied in Chile, Colombia, Hungary and Greece. On average, satisfaction levels have decreased slightly over time.
“The degree of cost sharing applied to those services also affects access to care. Across OECD countries, around 75% of all healthcare costs were covered by government or compulsory health insurance schemes in 2021. However, in Mexico only about 50% of all health spending was covered by publicly mandated schemes, and in Greece, Korea, Chile and Portugal only around 60% of all costs were covered.
“In terms of service coverage, on average across 25 OECD countries with comparable data, only 2.3% of the population reported that they had unmet care needs due to cost, distance or waiting times in 2021. However, over 5% of the population reported unmet needs in Estonia and Greece. Socio-economic disparities are significant in most countries, with the income gradient largest in Greece, Latvia and Türkiye.”
Source: OECD (2023), Health at a Glance 2023: OECD Indicators, OECD Publishing, Paris, doi.org/10.1787/7a7afb35-en.
“Very few countries have managed to improve service coverage and reduce catastrophic OOP health spending. Improvements in service coverage were seen in nearly all countries since 2000, while catastrophic spending worsened or saw little change in most countries (see Fig. 2). Since 2000, only42 of the 138 countries with available data for the same years for both UHC indicators achieved an expansion of service coverage, while reducing their respective share of the population incurring catastrophic OOP health spending. Moreover, the majority of countries (108/194) experienced worsening or no significant change in service coverage since the launch of the SDGs in 2015.2
“Compared to countries with higher income levels, low-income countries (LICs) and lower-middle-income countries (LMICs) saw the most significant improvements in the UHC service coverage index(UHC SCI) since 2000 and experienced the largest increases in catastrophic OOP health spending. While there was substantial regional variation in SDGs 3.8.1 and 3.8.2 levels when the SDGs era began in 2015, all regions have since shown the same pattern of stagnating service coverage and worsening financial hardship. The causes of this lack of progress vary by region and country, and addressing them requires context-specific policies.”
Source: Tracking universal health coverage: 2023 global monitoring report. Geneva: World Health Organization and International Bank for Reconstruction and Development / The World Bank; 2023.
“The population incurring catastrophic OOP [Out-Of-Pocket] health spending continuously increased globally since 2000 and surpassed 1 billion by 2019. Catastrophic OOP health spending reduces households’ ability to consume other essential goods and services such as food, shelter, clothing, or education. The global percentage of people living in households spending more than 10% of the household budget on OOP health expenses has continuously increased from 9.6% in 2000 to 12.6% in 2015 and reached 13.5% in 2019 (see Fig. 1). Overall, the estimated number of people incurring such relatively large OOP health spending increased by 76% during the same period from 588 million people in 2000 to 1.04 billion in 2019. Within countries, catastrophic OOP health spending is more prevalent among people living in households with older members (age 60 years or over). However, there is no strong relationship between countries’ income levels and catastrophic OOP health spending rates.
“The proportion of the global population with impoverishing OOP health spending decreased by 80% at the extreme poverty line between 2000 and 2019, but during the same period the rate with impoverishing OOP health spending at the relative poverty line increased by 42%. For people living in poverty or in near poverty, any amount of OOP health spending can be a source of financial hardship, even if it represents less than 10% of their household budget, as they have a lower capacity to pay for health care. The global population share with impoverishing OOP health spending at the extreme poverty line of US$2.15 a day in 2017 purchasing power parity reduced from 22.2% in 2000 to 15.6% in 2015 and 4.4% in 2019. However, the progress made in reducing impoverishing health spending for those living in extreme poverty or close to extreme poverty was partially offset by an increase in impoverishing health spending experienced by those living in relative poverty or near to relative poverty,3 which rose from 11.8% in 2000 to 15.8% in 2015 and 16.7% in 2019 (see Fig. 5).”
Source: Tracking universal health coverage: 2023 global monitoring report. Geneva: World Health Organization and International Bank for Reconstruction and Development / The World Bank; 2023.
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World Health Systems Facts currently has sections on the US and sixteen other OECD nations. The links below lead directly to national sections on Coverage and Equitable Access:
World Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems and policies in the US and sixteen other nations.
Page last updated September 5, 2025 by Doug McVay, Editor.