Insurance affordability is shaped by more than the price of a policy. Health payments can push households into poverty, while access to social protection and microinsurance remains sharply uneven by income level, gender and region. The statistics below show where coverage has improved, where financial hardship persists and how large the remaining protection gaps are.
Contents
- How health costs create financial hardship
- What social protection coverage reveals about affordability
- Microinsurance reach and affordability gaps
- Insurance spending and market penetration
- Protection gaps by risk and region
- Forecasts and financing needs
How health costs create financial hardship
The global health coverage picture improved between 2000 and 2023, but progress in access has not eliminated affordability problems. The UHC service-coverage index rose from 54 points in 2000 to 71 points in 2023 on its 0–100 scale. The index increased in 97% of countries over that period. (Tracking Universal Health Coverage (UHC): 2025 Global Monitoring Report)
Financial protection also improved in aggregate. The share of the global population facing financial hardship from out-of-pocket health spending fell from 34% in 2000 to 26% in 2022. The share experiencing impoverishing out-of-pocket payments declined from 29% in 2000 to 20% in 2022. However, the hardship measure declined in only 54% of countries, so global progress does not mean that affordability improved everywhere. (Tracking Universal Health Coverage (UHC): 2025 Global Monitoring Report)
The scale of the burden is visible in household spending data. In 2019, about 1 billion people spent more than 10% of their household budget on health out of pocket. In the same year, 1.3 billion people were pushed or further pushed into relative poverty by out-of-pocket health spending. (Universal health coverage global monitoring report 2023)
At the extreme-poverty line, 344 million people were impoverished or further impoverished by out-of-pocket health spending in 2019. This included 55 million people pushed into extreme poverty and 289 million people who were already poor and became further impoverished. These figures measure the consequences of paying directly for care, rather than the premium affordability of a particular insurance product. (Universal health coverage global monitoring report 2023)
The affordability challenge is expected to persist. The 2025 report projects that 24% of the global population will still face health-related financial hardship in 2030 if current trends continue. That is a forecast, not an observed 2030 outcome. (Tracking Universal Health Coverage (UHC): 2025 Global Monitoring Report)
What social protection coverage reveals about affordability
Social protection provides a broader affordability context because it can help households absorb illness, income loss and other shocks. In 2023, 52.4% of the world’s population was covered by at least one social-protection benefit, up from 42.8% in 2015. The ILO estimates that 3.8 billion people remained entirely unprotected in 2023. (World Social Protection Report 2024–26: Executive Summary)
Coverage varied considerably by national income group:
| Income group or population | Effective coverage in 2023 |
|---|---|
| High-income countries | 85.9% |
| Upper-middle-income countries | 71.2% |
| Lower-middle-income countries | 32.4% |
| Low-income countries | 9.7% |
Source: World Social Protection Report 2024–26: Executive Summary. Effective coverage means coverage by at least one social-protection benefit.
The gender gap is also material. Women’s effective social-protection coverage was 50.1% globally in 2023, compared with 54.6% for men. Only 33.8% of the working-age population was legally covered by comprehensive social-security systems. Within that measure, legal coverage was 39.3% for men and 28.2% for women. (World Social Protection Report 2024–26: Executive Summary)
Social assistance coverage among vulnerable people rose from 26.7% in 2015 to 37.3% in 2023, but climate exposure adds another affordability concern. Only 8.7% of the population in the 20 countries most vulnerable to climate change was covered by social protection in 2023. Across the 50 most climate-vulnerable countries, effective coverage was about 25%. (World Social Protection Report 2024–26: Executive Summary)
Microinsurance reach and affordability gaps
Microinsurance is designed to extend risk protection to people who may be underserved by conventional insurance, but its measured reach remains limited. The 2023 Landscape recorded 330 million people covered across 36 countries, using data from 2022. That represented 11.5% of the potential microinsurance market in the surveyed countries. (2023 Landscape Study: How data is the new Oil of Inclusive insurance)
The same study estimated a USD 41.1 billion microinsurance market in 2022. Premiums of USD 5.8 billion reached only 15% of that estimated market value. Premiums increased 12% from 2021 to 2022, while the number of people covered increased 28%. The market therefore expanded, but the reported premiums still represented a minority of the estimated opportunity. (2023 Landscape Study: How data is the new Oil of Inclusive insurance)
Product-line coverage in 2022 was concentrated in a few categories:
- Life and accident microinsurance covered 171 million people, the largest reported product-line total.
- Health microinsurance covered 72 million people.
- Agricultural microinsurance covered 33.6 million people.
- Motor, property and income-replacement microinsurance together covered 13 million people.
These product totals should not be added to estimate unique people protected, because one person may hold more than one type of cover. (2023 Landscape Study: How data is the new Oil of Inclusive insurance)
Distribution affects practical access as well as product availability. Almost 90% of people covered by the providers included in the 2022 Landscape used microfinance institutions, other financial institutions, agents or brokers as the distribution channel. Financial institutions distributed 54% of insured people in Africa, while microfinance insurance institutions distributed 53% of insured people in Asia. (2023 Landscape Study: How data is the new Oil of Inclusive insurance)
Insurance spending and market penetration
Insurance penetration provides a market-level indicator of premiums relative to economic output. Among OECD countries, average total insurance penetration was 6.2% of GDP in 2024, up from 6.0% in 2023. Across all OECD reporting jurisdictions, the average was 5.4% of GDP in 2024, up from 5.3% in 2023. (Global Insurance Market Trends 2025 — Insurance penetration)
The 2024 OECD-country average remained 0.4 percentage points below its 2014 level. Across all reporting jurisdictions, penetration remained 0.7 percentage points below its 2014 level. These comparisons describe premiums as a share of GDP; they do not directly show what individual households can afford. (Global Insurance Market Trends 2025 — Insurance penetration)
Country-level variation was wide in 2024. Total insurance penetration was 1.1% of GDP in Romania and 33% in Luxembourg. It was 1.2% in Paraguay, 1.4% in Guatemala, 1.5% in Nicaragua and 1.6% in Bolivia. (Global Insurance Market Trends 2025 — Insurance penetration)
Non-life insurance penetration averaged between 2.1% and 2.5% of GDP over 2014–2024 across reporting jurisdictions. In 2023, non-life premiums accounted for 55% of total premiums written on average among 54 reporting jurisdictions. They exceeded 80% of total premiums in Bulgaria, Croatia and Romania. Motor-vehicle insurance premiums accounted for more than one-third of non-life premiums on average among reporting jurisdictions in 2023. (Global Insurance Market Trends 2025 — Insurance penetration)
Protection gaps by risk and region
The insurance protection gap captures risks that are not covered or are insufficiently covered, expressed here in premium-equivalent terms. The global gap reached USD 1.83 trillion in 2023, compared with a restated USD 1.77 trillion in 2022. It grew 3.1% in nominal terms from 2022 to 2023 and at an average annual nominal rate of 3.6% from 2013 to 2023. (sigma Resilience Index 2024: Encouraging resilience gains, but more is needed)
Health was the largest quantified risk gap in the supplied measures: the global health protection gap grew 5.4% to USD 941 billion in premium-equivalent terms in 2023. The global crop insurance protection gap stood at USD 77 billion in 2023. (sigma Resilience Index 2024: Encouraging resilience gains, but more is needed)
Natural-catastrophe protection was also limited. The global natural-catastrophe insurance resilience index was 25.7% in 2023, implying a USD 385 billion protection gap. Three quarters of global natural-disaster exposure was not protected by insurance in 2023. (sigma Resilience Index 2024: Encouraging resilience gains, but more is needed)
Forecasts and financing needs
The pace of expansion matters as much as the current coverage rate. At the 2023 pace of global social-protection expansion, universal coverage by at least one benefit would not be reached until 2073. This is a projection based on that pace, not a fixed deadline. (World Social Protection Report 2024–26: Executive Summary)
Low- and middle-income countries need an additional USD 1.4 trillion per year for a basic social-protection floor, equal to 3.3% of their aggregate 2024 GDP. Within that estimate, the annual financing need for essential health care is USD 833.4 billion, or 2.0% of aggregate GDP. The additional need for five social-protection cash benefits is USD 552.3 billion, or 1.3% of aggregate GDP. (World Social Protection Report 2024–26: Executive Summary)
The relative burden is especially high in low-income countries. They would need an additional USD 308.5 billion per year for a basic social-protection floor, equivalent to 52.3% of their GDP. Average social-protection spending excluding health was 12.9% of GDP globally in 2023, compared with 16.2% in high-income countries and 0.8% in low-income countries. (World Social Protection Report 2024–26: Executive Summary)
Health protection remains incomplete even where legal entitlements are broader. Globally, 60.1% of people were effectively protected by a health-protection scheme in 2023, while 83.7% were covered by law. The ILO estimated that 3.3 billion people lacked effective health-protection coverage in 2023. (World Social Protection Report 2024–26: Executive Summary)
Older people’s protection also differs by region. Global public expenditure on pensions and other non-health benefits for older people averaged 7.6% of GDP in 2023, ranging from 10.5% in Europe and Central Asia to 1.7% in Africa. (World Social Protection Report 2024–26: Executive Summary)