Every human being has the right to health, which is 'the highest attainable standard of physical and mental health'. This fundamental right obliges countries to create and implement legislation and policies that guarantee universal access to quality health services and address the root causes of health disparities, including poverty, stigma, and discrimination.
In line with this, the World Health Organisation (WHO) and the World Bank Group have jointly released the UHC Global Monitoring Report 2025, highlighting progress made and challenges that persist in achieving universal health coverage (UHC) globally.
The report indicates that health service coverage, as measured by the Service Coverage Index (SCI), increased from 54 to 71 points between 2000 and 2023. Meanwhile, the share of people experiencing financial hardship due to large and impoverishing out-of-pocket (OOP) health payments declined from 34 per cent to 26 per cent between 2000 and 2022.
However, the report cautions that the poorest populations continue to bear the greatest burden of unaffordable health costs, with 160 crore people further pushed into poverty. Overall, an estimated 460 crore people worldwide still lack access to essential health services, and 210 crore experience financial hardship to access healthcare.
Global progress in health coverage
“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.”
Financial hardship in health is defined as a household spending more than 40 per cent of its discretionary budget on OOP health expenses. The report underscores that medicines are a major driver of financial hardship; in three-quarters of countries with available data, medicines account for at least 55 per cent of people’s OOP health expenses. Among people living in poverty, this burden is even higher, with a median of 60 per cent of OOP expenses going toward medicines, diverting scarce resources from other essential needs.
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While OOP costs primarily burdens the poor, they also affect better-off populations, particularly in middle-income countries where this demographic is expanding. The report warns that without faster progress, full-service coverage without financial hardship will remain out of reach; the global SCI is projected to reach only 74 out of 100 by 2030, with nearly one in four people worldwide still facing financial hardship by the end of the Sustainable Development Goals (SDG) era.
Encouragingly, low-income countries, despite starting from lower baselines, have achieved the fastest gains in both health service coverage and financial protection. “The global increase in health service coverage has been driven largely by advances in infectious disease programmes. Coverage for noncommunicable diseases (NCDs) has shown steady improvement, while gains in reproductive, maternal, newborn, and child health have been modest,” the report added.
The report notes that improved sanitation has supported service coverage gains. “At the same time, inclusive economic growth, rising incomes, and stronger social protection mechanisms have driven poverty reduction, especially in low-income countries, contributing to declines in financial hardship,” the report says. “However, health costs have increasingly become a source of financial hardship among the poor.”
Inequalities in health access persist
Despite global progress, health inequalities remain stark. In 2022, three out of four people among the poorest segments of the population faced financial hardship due to health costs, compared with fewer than one in 25 among the richest. Women, people living in poverty or rural areas, and those with lower education reported greater difficulties in accessing essential health services.
Even in high-performing regions such as Europe, vulnerable groups, including the poorest and people with disabilities, continue to report higher unmet health needs. The report also notes that its data may underestimate true health disparities, as the most vulnerable groups, such as displaced populations and residents of informal settlements, are often missing in the datasets used to monitor UHC progress.
The report highlights six core areas for action to achieve UHC by 2030—to “ensure essential health care is free at the point of care for people living in poverty and vulnerable situations; expand public investments in health systems; address high out-of-pocket spending on medicines; accelerate access to essential NCD services, especially as the disease burden rises; strengthen primary health care to promote equity and efficiency; and adopt multisectoral approaches, recognising that determinants of health and UHC drivers extend beyond the health sector.”
Financial hardship, medicines, and OOP expenses
The cost of medicines continues to be the main driver of financial hardship. WHO–World Bank data indicate that while global OOP expenses have declined from 34 per cent in 2000 to 26 per cent in 2022, the burden remains concentrated among the poorest. High prices for essential drugs, diagnostic tests, and hospitalisation force households to divert money from food, education, and other critical needs.
The report stresses that medicines account for over half of OOP health expenses globally, with a median of 60 per cent among the poorest. Without systematic price controls, universal health coverage cannot be achieved, as financial risk protection is a critical pillar alongside service availability. This concern is amplified by rising NCD prevalence, as diseases like diabetes, cardiovascular disease, and cancer require long-term, often expensive medication and treatment.
Implications for India
India’s progress towards Universal Health Coverage presents a mixed picture of measurable gains alongside persistent structural gaps. According to the WHO–World Bank assessment of Sustainable Development Goal (SDG) indicators, India’s UHC Service Coverage Index stood at 69 in 2023, reflecting expanded access to essential health services such as maternal care, immunisation, and control of infectious diseases. However, financial protection remains a concern, with 30.9 per cent of the population experiencing financial hardship due to health-related expenses as of 2022.
Over the past decade, the Government of India has substantially increased public investment in health. As outlined in a recent Lok Sabha reply, the National Health Policy, 2017, envisions public health spending to reach 2.5 per cent of GDP by 2025. Correspondingly, National Health Accounts estimates show that government health spending as a share of total health expenditure rose from 29 per cent in 2014–15 to 48 per cent in 2021–22, while government health expenditure as a percentage of GDP increased from 1.13 per cent to 1.84 per cent during the same period. The budget allocation for the Department of Health and Family Welfare more than doubled, from Rs 47,353 crore in 2017–18 to Rs 95,957.87 crore in 2025–26, reflecting a 102.64 per cent rise. Additional support has come through the Fifteenth Finance Commission, which allocated Rs 70,051 crore in health grants to local governments between 2020–21 and 2025–26.
As per National Health Accounts data, OOPE as a share of total health expenditure declined significantly from 62.6 per cent in 2014–15 to 39.4 per cent in 2021–22. India now ranks 69th among 189 countries in per capita OOPE (PPP-adjusted), indicating a relative improvement in financial protection. Government initiatives under the National Health Mission, including Ayushman Arogya Mandirs, free drugs and diagnostics schemes, national dialysis services, and strengthened ambulance and community health worker networks, have contributed to this downward trend.
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), which provides health insurance cover of up to Rs 5 lakh per family per year for secondary and tertiary care to over 12 crore economically vulnerable families, has expanded steadily, with states supplementing coverage at their own cost. In March 2024, nearly 37 lakh families of ASHA and Anganwadi workers were included, and in September 2024, the Union Cabinet approved a landmark expansion granting universal coverage to all senior citizens aged 70 and above, irrespective of income, benefiting an estimated 4.5 crore families and 6 crore elderly persons. As of June 30, 2025, the Ayushman Bharat PM-JAY scheme had generated over 41 crore Ayushman cards across India, with the highest numbers coming from Uttar Pradesh (5.33 crore), Madhya Pradesh (4.35 crore), Bihar (3.91 crore), Odisha (3.46 crore), Maharashtra (3.17 crore), and Rajasthan (2.25 crore).
Parallel efforts to control healthcare costs have focused on regulating medicine prices. Through the National Pharmaceutical Pricing Authority, ceiling prices have been fixed for 935 essential formulations, retail prices notified for over 3,600 new drugs, and trade margins capped for select anti-cancer and cardiovascular treatments. These measures have helped ensure “annual savings of up to Rs 25,000 crore.”
Despite these advances, significant challenges persist. India’s disease burden has shifted decisively toward non-communicable diseases, which accounted for 61.8 per cent of all deaths as early as 2017, according to the Indian Council of Medical Research. Cardiovascular diseases, cancers, chronic respiratory illnesses, and diabetes-related conditions dominate mortality trends, placing sustained pressure on long-term care systems and household finances.
Insurance coverage also remains uneven. NITI Aayog’s 2021 data shows that close to 40 crore people in India lack any form of health insurance coverage. While roughly 70 per cent of the population is enrolled under public health insurance schemes or private voluntary policies, the remaining nearly 30 per cent, amounting to over 40 crore individuals, still remain without health insurance protection.
Vulnerable groups face particular exclusion, an NCPEDP white paper published in November highlighted how India’s 16 crore persons with disabilities remain largely locked out of both public and private insurance frameworks.
These gaps help explain why financial hardship remains widespread despite declining OOPE. Government estimates in 2018 suggest that as many as 6.3 crore Indians, nearly 7 per cent of the population, were pushed below the poverty line due to health spending.
This story is done in collaboration with First Check, which is the health journalism vertical of DataLEADS.
