Achieving universal health coverage (UHC) remains a critical global objective, yet current trends indicate that the world is falling short of this goal despite notable progress over the past two decades. As populations grow and health systems evolve, ensuring equitable access to quality health services without financial hardship is more important than ever. This comprehensive overview explores the key facts, ongoing challenges, and strategic directions to advance UHC worldwide.
Key Facts
Despite early advancements, the global journey toward UHC has recently slowed. Since 2000, the UHC service coverage index has increased from 54 to 71. However, the rate of progress has declined significantly after 2015, with gains during this period only one-third of the pre-2015 pace. The proportion of people lacking access to essential health services decreased by approximately 20% between 2000 and 2023, yet around 4.6 billion individuals still remain without full coverage of necessary health interventions.
In 2022, an estimated 2.1 billion people experienced financial hardship due to health expenses, including 1.6 billion living in or pushed deeper into poverty. This figure represents about 26% of the global population, a decline from 34% in 2000. While all WHO regions have made progress in expanding service coverage, disparities persist, especially in reducing financial strain, with some regions making more significant strides than others.
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Overview
Universal health coverage ensures that everyone has access to a full spectrum of high-quality health services—ranging from health promotion and disease prevention to treatment, rehabilitation, and palliative care—regardless of their economic or social circumstances. It emphasizes the importance of accessible services across all stages of life, promoting health equity and social justice.
The global commitment to UHC was reinforced when nations adopted the Sustainable Development Goals (SDGs) in 2015, recognizing health as a cornerstone of sustainable development. The 2019 UN High-Level Meeting on UHC reaffirmed that health is both a precondition for and an outcome of broader social, economic, and environmental development. To monitor progress, the United Nations Statistical Commission approved revised indicators, including the SDG indicator 3.8.1: UHC service coverage index and SDG indicator 3.8.2: proportion of the population facing financial hardship in health. Accurate measurement of these indicators is vital for guiding policy and resource allocation.
Progress towards UHC
Between 2000 and 2015, the global community achieved significant improvements in both UHC indicators. The service coverage index grew at an annual rate of 1.5%, and the reduction in financial hardship was notably faster, decreasing by approximately 0.37 percentage points annually. However, since 2015, progress has notably slowed: the service coverage index has only increased by about 0.5% annually, and the decline in financial hardship has similarly decelerated.
Current projections suggest that, at this slower pace, the world will not reach the 2030 UHC goals. The global service coverage index is expected to be around 74 out of 100, with 24% of the population still experiencing financial hardship related to health expenses. Much of the progress in expanding health services has been driven by efforts to control infectious diseases, accounting for over half of the improvements since 2000. Conversely, reproductive, maternal, newborn, and child health services have stagnated, hovering around an index score of 72, while care for noncommunicable diseases (NCDs) lags behind, reaching only 61 in 2023.
The disparities in service coverage have narrowed over time, with fewer countries categorized as having low or very low coverage—dropping from 55 in 2000 to just 8 in 2023. Nonetheless, inequalities within countries remain a significant obstacle. Data from Europe in 2019 reveal that the poorest segments face higher unmet healthcare needs, with median unmet need rates of 32% among the lowest income groups compared to 22% among the wealthiest. Similar disparities exist for individuals with disabilities, rural residents, and household structures with older adults.
In terms of financial hardship, approximately three out of four people in the poorest populations faced economic strain from health costs in 2022, contrasted with fewer than 1 in 25 in the wealthiest groups. Vulnerable groups, including rural residents and multigenerational households, especially those with seniors, tend to experience higher rates of financial hardship. These patterns underscore the necessity for policies that reduce out-of-pocket payments, expand access to essential services, and strengthen publicly funded health coverage.
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Efforts to improve UHC must also focus on strengthening health system governance, ensuring compliance with quality standards, and integrating innovative technologies such as artificial intelligence, which is increasingly used across healthcare ecosystems. For an in-depth look at these technological integrations, see mapping the sector where is AI used in healthcare ecosystems.
Challenges and the Way Forward
Despite advances, the path to universal health coverage faces several persistent challenges. Inequalities within countries, driven by economic, geographic, and social factors, continue to hinder equitable access. Addressing these disparities requires targeted policies that focus on vulnerable populations, including the poor, rural communities, and marginalized groups.
Reducing out-of-pocket spending remains a priority. Governments should expand publicly funded coverage, improve health financing mechanisms, and implement multisectoral strategies that address social determinants of health. Strengthening health system resilience and ensuring data privacy and security are essential for building trust and efficiency.
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Achieving UHC requires global cooperation, innovation, and a steadfast commitment to health equity. Continuous monitoring, informed by robust data collection and analysis, will be vital to overcoming existing gaps and reaching the ambitious 2030 target.