On Thursday, a high-level meeting of government officials will take place during the 78th session of the United Nations General Assembly to discuss global progress towards achieving Universal Health Coverage (UHC) by 2030. Governments serious about meeting this target, one of the UN’s 17 Sustainable Development Goals, should begin by putting their money where their mouth is.
UHC is a concept grounded in the right to health, recognizing that all people should have access to the quality health services they need, when and where they need them, without financial hardship.
There is no “magic number” for health care spending that meets countries’ right to health obligations. The United States spends more on health care than any other country, but its largely market-based healthcare system produces immense disparities of access and quality.
Numerous studies, including from the World Health Organization (WHO), have estimated that providing UHC will generally require governments to spend the equivalent of at least 5 to 7.5 per cent of their Gross Domestic Product (GDP) on health care.
However, when Human Rights Watch analyzed WHO healthcare expenditure data, we found that 132 governments spent less than 5% of their GDP on health care on average between 2019 and 2021, calling into question their commitment to fulfilling right to health obligations.
In that same period, households in 47 countries collectively paid more out-of-pocket for health care than what their governments spent on it. In Nigeria, the largest economy in Africa, households’ out-of-pocket health care costs were more than 4.7-times what the government spent on health care. In India, the world’s fifth-largest economy, household out-of-pocket costs were about 50 percent higher than government spending, accounting for more than half of all health care costs.
Reliance on out-of-pocket expenses can increase inequalities, as not everyone will be able to cover these costs, widening gaps in quality of life and life expectancy instead of ensuring the availability, accessibility, acceptability, and quality of health care.
As governments meet to discuss the future of UHC, they should commit to reducing the burden on households to finance health care by ensuring high-quality, public health care services for all, aligned with the right to health.
Read this data in table format World Health Care Expenditures (% of GDP)Three-Year Averages (2019-2021) Country Domestic General Government (Public) Household Out-of-Pocket Other (Private Insurance, External) Total Current Health Expenditure (CHE) Tuvalu 16.85% 0.07% 4.30% 21.21% Cuba 10.61% 1.17% 0.01% 11.79% Palau 10.11% 1.95% 4.99% 17.05% Nauru 9.91% 0.10% 2.07% 12.08% Germany 9.68% 1.62% 1.14% 12.44% United States of America 9.61% 1.88% 6.25% 17.75% Sweden 9.55% 1.49% 0.12% 11.16% Kiribati 9.33% 0.01% 2.17% 11.51% United Kingdom 9.23% 1.69% 0.34% 11.26% Norway 9.15% 1.49% 0.04% 10.68% Japan 9.10% 1.38% 0.35% 10.83% Denmark 8.89% 1.36% 0.25% 10.50% France 8.85% 1.07% 1.73% 11.65% Canada 8.67% 1.58% 1.61% 11.86% Austria 8.60% 1.97% 0.80% 11.37% Belgium 8.43% 1.90% 0.53% 10.86% Australia 7.77% 1.49% 1.18% 10.44% Iceland 7.69% 1.40% 0.16% 9.25% Finland 7.59% 1.59% 0.22% 9.39% San Marino 7.58% 0.89% 0.05% 8.52% Maldives 7.52% 1.63% 0.35% 9.50% New Zealand 7.45% 1.16% 1.15% 9.76% Netherlands (Kingdom of the) 7.29% 1.08% 2.46% 10.83% Czech Republic 7.25% 1.08% 0.10% 8.42% Spain 7.14% 2.05% 0.73% 9.93% Italy 6.93% 2.07% 0.25% 9.25% Marshall Islands 6.59% 0.16% 7.17% 13.92% Slovenia 6.55% 1.09% 1.40% 9.04% Portugal 6.53% 3.04% 0.85% 10.42% Bosnia and Herzegovina 6.53% 2.75% 0.17% 9.45% Malta 6.48% 3.23% 0.32% 10.04% Uruguay 6.41% 1.49% 1.37% 9.27% Argentina 6.34% 2.48% 0.91% 9.73% Colombia 6.15% 1.19% 1.22% 8.55% Montenegro 6.09% 3.71% 0.08% 9.88% Andorra 5.96% 0.97% 1.30% 8.23% Croatia 5.96% 0.80% 0.53% 7.29% Slovakia 5.64% 1.34% 0.11% 7.09% Estonia 5.56% 1.68% 0.11% 7.35% Lesotho 5.55% 1.66% 4.39% 11.59% Costa Rica 5.44% 1.61% 0.49% 7.54% Niue 5.35% 0.07% 2.10% 7.52% Israel 5.35% 1.51% 1.04% 7.90% Panama 5.32% 3.10% 0.57% 9.00% Nicaragua 5.30% 2.81% 0.48% 8.59% Ireland 5.28% 0.74% 0.81% 6.83% Bolivia Plurinational States of 5.27% 1.67% 0.43% 7.37% El Salvador 5.26% 3.16% 0.76% 9.18% Suriname 5.23% 1.36% 1.01% 7.60% Kuwait 5.19% 0.58% 0.06% 5.83% Serbia 5.19% 3.17% 0.34% 8.70% Chile 5.14% 2.85% 1.40% 9.39% South Africa 5.07% 0.47% 2.88% 8.41% Republic of Korea 5.05% 2.33% 0.87% 8.25% Cyprus 5.02% 1.73% 0.77% 7.52% 5% GDP 5.00% Lithuania 4.99% 2.27% 0.20% 7.46% Ecuador 4.90% 2.64% 0.61% 8.15% Romania 4.81% 1.14% 0.06% 6.01% Luxembourg 4.79% 0.49% 0.24% 5.52% Hungary 4.72% 1.81% 0.25% 6.77% Poland 4.66% 1.32% 0.53% 6.51% Bulgaria 4.64% 2.95% 0.21% 7.80% Greece 4.55% 2.97% 1.34% 8.86% Belize 4.52% 1.49% 0.49% 6.50% The Republic of North Macedonia 4.51% 2.91% 0.05% 7.48% Botswana 4.50% 0.28% 1.38% 6.15% Timor-Leste 4.46% 0.68% 2.76% 7.90% Seychelles 4.43% 1.11% 0.10% 5.63% Russian Federation 4.36% 2.13% 0.13% 6.62% Latvia 4.34% 2.37% 0.33% 7.03% Belarus 4.33% 1.55% 0.25% 6.13% Oman 4.32% 0.26% 0.28% 4.86% Brazil 4.26% 2.36% 3.35% 9.96% Jamaica 4.23% 1.00% 1.12% 6.35% Samoa 4.23% 0.63% 0.81% 5.67% Namibia 4.20% 0.67% 3.81% 8.68% Republic of Moldova 4.09% 2.19% 0.29% 6.57% Algeria 4.01% 2.18% 0.10% 6.29% Switzerland 3.91% 2.73% 4.90% 11.54% Bahamas 3.80% 1.62% 1.32% 6.75% Jordan 3.79% 2.28% 1.45% 7.52% Peru 3.77% 1.47% 0.53% 5.76% Paraguay 3.71% 2.96% 0.70% 7.37% Türkiye 3.51% 0.75% 0.22% 4.49% Solomon Islands 3.48% 0.17% 0.80% 4.45% Cabo Verde Republic of 3.48% 1.39% 0.68% 5.54% Ukraine 3.46% 3.64% 0.26% 7.36% Guyana 3.46% 1.52% 0.24% 5.22% Eswatini 3.43% 0.72% 2.47% 6.63% Dominica 3.41% 1.70% 0.27% 5.39% Trinidad and Tobago 3.26% 3.29% 0.52% 7.07% Tunisia 3.26% 2.34% 0.31% 5.91% Honduras 3.25% 4.36% 0.87% 8.48% Barbados 3.24% 2.92% 0.53% 6.70% Mauritius 3.19% 2.80% 0.44% 6.43% Lebanon 3.09% 3.19% 1.65% 7.93% Saint Vincent and the Grenadines 3.07% 1.27% 0.24% 4.57% China 3.03% 1.92% 0.53% 5.47% Bhutan 3.02% 0.66% 0.30% 3.99% Qatar 3.01% 0.38% 0.46% 3.85% Micronesia (Federated States of) 3.00% 0.29% 8.12% 11.41% Mexico 2.98% 2.37% 0.49% 5.84% Tonga 2.97% 0.26% 1.80% 5.03% Antigua and Barbuda 2.96% 1.18% 0.85% 5.00% Thailand 2.93% 0.39% 0.79% 4.11% Iran 2.92% 2.16% 0.57% 5.64% Dominican Republic 2.91% 1.21% 0.47% 4.59% Cook Islands 2.84% 0.22% 0.10% 3.16% United Arab Emirates 2.82% 0.59% 1.57% 4.99% Mongolia 2.81% 1.32% 0.43% 4.55% Georgia 2.76% 3.34% 1.04% 7.13% Singapore 2.73% 1.24% 1.27% 5.23% Rwanda 2.71% 0.77% 3.34% 6.82% Uzbekistan 2.67% 3.37% 0.04% 6.09% Bahrain 2.63% 1.23% 0.49% 4.34% Saint Kitts and Nevis 2.59% 2.34% 0.22% 5.15% Burkina Faso 2.58% 2.10% 1.37% 6.05% Fiji 2.53% 0.51% 0.74% 3.78% Saint Lucia 2.48% 2.37% 0.68% 5.54% Sao Tome and Principe 2.43% 0.98% 1.65% 5.07% Iraq 2.43% 2.22% 0.02% 4.67% Guatemala 2.43% 3.55% 0.35% 6.33% Burundi 2.40% 1.99% 2.13% 6.52% Morocco 2.39% 2.50% 0.79% 5.68% Kyrgyzstan 2.35% 2.25% 0.28% 4.88% Zambia 2.29% 0.52% 2.66% 5.47% Vanuatu 2.24% 0.28% 1.12% 3.64% Niger 2.18% 2.65% 1.10% 5.93% Grenada 2.17% 2.96% 0.24% 5.38% Brunei Darussalam 2.16% 0.13% 0.00% 2.29% Philippines 2.14% 2.24% 0.58% 4.96% Mozambique 2.14% 0.76% 4.89% 7.79% Malaysia 2.09% 1.43% 0.46% 3.98% Viet Nam 2.08% 2.06% 0.72% 4.86% Kazakhstan 2.07% 1.01% 0.21% 3.29% Tajikistan 2.03% 5.16% 0.38% 7.56% Kenya 2.02% 1.05% 1.26% 4.33% Cambodia 1.87% 4.50% 0.83% 7.20% Armenia 1.87% 9.60% 0.34% 11.81% Malawi 1.82% 0.96% 2.50% 5.29% Gabon 1.79% 0.67% 0.64% 3.10% Sri Lanka 1.68% 1.89% 0.30% 3.86% Ghana 1.67% 1.23% 0.79% 3.69% Indonesia 1.64% 1.05% 0.47% 3.16% United Republic of Tanzania 1.59% 0.86% 1.37% 3.81% Papua New Guinea 1.53% 0.22% 0.67% 2.43% Congo 1.53% 1.18% 0.80% 3.52% Liberia 1.47% 4.54% 2.96% 8.97% Azerbaijan 1.43% 2.90% 0.01% 4.34% Mali 1.40% 1.22% 1.48% 4.09% Egypt 1.38% 2.80% 0.42% 4.60% Monaco 1.38% 0.12% 0.10% 1.60% Senegal 1.37% 2.18% 1.27% 4.82% Gambia 1.35% 0.63% 0.91% 2.89% Madagascar 1.33% 1.27% 1.23% 3.83% Nepal 1.32% 2.70% 0.79% 4.81% Sierra Leone 1.30% 4.88% 2.62% 8.80% Mauritania 1.30% 1.54% 0.52% 3.35% Venezuela (Bolivarian Republic of) 1.22% 0.90% 0.88% 3.00% Côte d'Ivoire 1.17% 1.21% 1.12% 3.51% Angola 1.16% 1.04% 0.58% 2.78% Sudan 1.07% 2.29% 0.47% 3.83% Lao People's Democratic Republic 1.06% 1.11% 0.48% 2.65% Togo 1.05% 3.73% 1.02% 5.80% India 1.03% 1.53% 0.38% 2.95% Turkmenistan 1.01% 4.38% 0.30% 5.68% Central African Republic 1.01% 4.86% 2.75% 8.62% Pakistan 0.99% 1.62% 0.29% 2.90% Djibouti 0.99% 0.58% 0.44% 2.01% Guinea 0.94% 2.16% 0.95% 4.06% Ethiopia 0.85% 1.19% 1.31% 3.36% Eritrea 0.82% 1.89% 1.57% 4.28% Chad 0.81% 3.02% 1.11% 4.94% Comoros 0.80% 3.41% 1.05% 5.26% Afghanistan 0.75% 12.00% 2.98% 15.73% Equatorial Guinea 0.74% 2.54% 0.12% 3.40% Myanmar 0.74% 3.59% 0.33% 4.65% Benin 0.70% 1.07% 0.68% 2.45% Zimbabwe 0.64% 0.35% 2.55% 3.54% Uganda 0.62% 1.47% 1.79% 3.88% Guinea-Bissau 0.62% 5.43% 2.33% 8.38% Democratic Republic of the Congo 0.61% 1.48% 1.71% 3.80% South Sudan 0.60% 1.14% 3.22% 4.96% Cameroon 0.51% 2.60% 0.60% 3.71% Bangladesh 0.50% 1.92% 0.21% 2.62% Nigeria 0.49% 2.33% 0.37% 3.18% Haiti 0.41% 1.53% 1.62% 3.57%