Global Progress Towards Universal Health Coverage: A 2024 Perspective

The World Health Organization (WHO) defines universal health coverage (UHC) as the ability for all individuals to access comprehensive health services without incurring financial difficulty. By 2025, 73 countries had achieved UHC, impacting approximately 69% of the global population. However, recent data from the WHO-World Bank Universal Health Coverage Global Monitoring Report shows a slowdown in the improvement rate of UHC service coverage, from an annual 1.5% between 2000-2015 to just 0.5% over the past decade.

The United States remains an outlier among developed countries, lacking universal healthcare for its working-age population. According to the US Census Bureau, 27.1 million Americans were uninsured in 2024, constituting 8% of the population. While Medicare, Medicaid, CHIP, and the Veterans Health Administration provide coverage to specific groups, 11.3% of adults aged 19 to 64 still lack insurance. Notably, ACA marketplace enrollments reached 24.2 million by 2025 due to enhanced subsidies, but with these set to expire, the Congressional Budget Office projects up to 14 million individuals could remain uninsured by 2034.

China has made significant strides towards UHC with the Urban Employee Basic Medical Insurance and Urban-Rural Resident Basic Medical Insurance schemes, covering 95% of its population by 2024. Nonetheless, gaps persist, particularly among migrant workers and uninsured segments. Financial challenges remain as well, with out-of-pocket spending accounting for 34% of total health expenditures in 2021, compared to the OECD average.

India's healthcare framework includes the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), targeting the poorest 40% of households. By 2024, 350 million individuals held PMJAY cards. However, out-of-pocket expenses still dominate healthcare spending, and state-level schemes offer only limited additional coverage.

Pakistan's Sehat Sahulat Program has expanded since 2019, covering 45 million families with inpatient services, but outpatient care and medicines remain underfunded. Health expenditures are at only 2.9% of GDP, with IMF fiscal constraints hindering further expansion efforts.

Nigeria's National Health Insurance Authority Act mandates health insurance enrollment, yet as of 2024, only about 18 million people are covered. With aims to reach 50% coverage by 2030, analysts predict this goal remains elusive.

In Egypt, the Universal Health Insurance Law began its rollout in 2019, reaching six governorates by 2025. Despite plans for further expansion, substantial portions of the population remain without access, particularly in major urban areas. South Africa's National Health Insurance implementation faces legal delays, maintaining a dual healthcare system that continues to segregate publicly funded and private healthcare services.

As conflicts have devastated healthcare systems in Yemen, Syria, and Afghanistan, these countries fall outside the UHC discourse. Meanwhile, many nations struggle with significant coverage gaps and out-of-pocket expenses, challenging the WHO's goals for achieving universal health coverage by 2030.