Insurance coverage statistics show progress alongside large protection gaps. The global UHC service coverage index rose from 54 points in 2000 to 71 in 2023, yet about 4.6 billion people still lacked access to essential health services in 2023. Social protection was similarly uneven: 52.4% of the world’s population had at least one benefit in 2023, leaving 47.6% without coverage. Microinsurance reached 344 million people across 37 countries in three regions in 2023, but reported coverage remained concentrated in Asia-Pacific and reached only 13% of people there.
Contents
- Global health coverage and protection gaps
- Health insurance and financial protection
- Coverage by life risk
- Pensions, income security and legal coverage
- Insurance market penetration
- Microinsurance reach and regional concentration
Global health coverage and protection gaps
The World Health Organization’s Tracking universal health coverage: 2025 global monitoring report records a long-term improvement in service access. The global UHC service coverage index was 54 points in 2000 and reached 71 points in 2023. The index is a service-coverage measure, so it should be read alongside financial-protection indicators rather than treated as a direct measure of how many people hold an insurance policy.
Financial hardship from out-of-pocket health spending also declined, but remained widespread. The share of the global population facing this hardship fell from 34% in 2000 to 26% in 2022. In absolute terms, about 2.1 billion people faced financial hardship from out-of-pocket health spending in 2022. The measurement years differ: the service index is reported for 2023, while the hardship estimate is reported for 2022.
The pace of improvement has not been uniform. Among countries and territories with at least two data points, 53% improved both UHC dimensions between 2000 and 2022/2023. For the more recent period from 2015 to 2022/2023, 38% improved both dimensions. These figures describe countries and territories with sufficient observations; they are not a percentage of the world’s population.
The WHO report also presents a conditional projection. If the pace observed from 2015 to 2022/2023 continues, the global UHC service coverage index is projected to reach about 74 points in 2030, while 24% of the global population is projected to face health-related financial hardship. These are estimates based on continuation of the stated pace, not observed 2030 outcomes.
Health insurance and financial protection
The composition of health-service progress helps explain why a higher coverage index does not eliminate the need for financial protection. Infectious-disease indicators accounted for 52% of the rise in the global UHC service coverage index from 2000 to 2023. Basic sanitation, insecticide-treated nets and tobacco non-use together accounted for 78% of the change over the same period, while the noncommunicable-disease sub-index contributed 27% of global UHC service-coverage gains.
Income differences remain pronounced. In 2015, low-income countries had a UHC service coverage score of 43, about half the high-income-country score of 85. The financial-hardship rate was 38.5% in low-income countries compared with 9.5% in high-income countries. The paired figures point to two separate dimensions of protection: whether services are available and whether using health care creates financial strain.
OECD data provide a more detailed view of what compulsory or government schemes pay for. Across OECD countries, these schemes covered around three-quarters of all health-care costs in 2021. They covered 90% of inpatient-care costs, 79% of outpatient medical-care costs and 56% of pharmaceutical costs on average. Dental care was the most limited of these categories: government or compulsory schemes covered less than one-third of dental-care costs on average.
| Health-care category | Government or compulsory coverage across OECD countries, 2021 |
|---|---|
| All health-care costs | Around 75% |
| Inpatient care | 90% |
| Outpatient medical care | 79% |
| Pharmaceutical costs | 56% |
| Dental care | Less than one-third |
Country variation is substantial even within the OECD. Inpatient-care coverage was near 100% in Sweden, Norway, Iceland and Estonia, but only around two-thirds in Australia, Greece and Korea. Outpatient medical-care coverage was under 60% in Portugal and Korea and exceeded 90% in the Czech Republic, Slovak Republic, Denmark and the United Kingdom.
Pharmaceutical protection also differed. Government or compulsory schemes covered 83% of pharmaceutical costs in France, 82% in Ireland and 82% in Germany in 2021. Dental spending was covered by government or compulsory schemes for more than half of total spending in Japan, Germany and France. These OECD figures measure the share of costs financed by specified schemes, not the share of residents enrolled in any particular private insurance product.
Coverage by life risk
The World Social Protection Report 2024-26: Executive Summary measures protection across major life risks. In 2023, 52.4% of the world’s population was covered by at least one social-protection benefit. The remaining 47.6% had no social-protection coverage. This broad indicator includes at least one benefit and therefore does not mean that beneficiaries were protected against every risk.
Maternity protection covered a minority of those who needed it. Cash maternity benefits reached 36.4% of women with newborns worldwide in 2023, leaving about 85 million women with newborns without this benefit. Coverage rose by 6.8 percentage points between 2015 and 2023.
Sickness and employment-injury protection also left large groups exposed. Sickness benefits legally covered 56.1% of the global labour force in 2023, but only 34.4% of the global working-age population. About 4.1 billion working-age people were not legally protected by sickness benefits. Employment-injury protection covered 37.4% of workers globally, while about 2.3 billion workers were totally uncovered for employment injury.
Disability and unemployment benefits were less widespread. Disability benefits reached 38.9% of people with severe disabilities in 2023, leaving about 146 million people in that group without coverage. Unemployment cash benefits reached 16.7% of unemployed people worldwide, and about 157 million unemployed people were not covered by unemployment cash benefits.
Retirement coverage was broader than several working-age protections, though it was not universal. A pension was received by 79.6% of people above statutory retirement age worldwide in 2023. More than 165 million people above statutory retirement age did not receive a pension.
Pensions, income security and legal coverage
Pension statistics differ depending on whether they measure receipt of a benefit, legal eligibility or active contributions. The ILO’s World Social Protection Report 2024-26: Chapter 4 reports that statutory mandatory or voluntary contributory pension schemes legally covered 51.4% of the global working-age population in 2023 or the latest available year. Mandatory contributory schemes legally covered 39.4%, while voluntary contributory schemes legally covered an additional 12.0%.
Active contributions tell a different story from legal coverage. Active pension contributions covered 58.5% of the global labour force in 2023 or the latest available year. The populations and measures are not identical: legal coverage refers to the working-age population, while active contributions refer to the labour force. Comparing them directly as an enrollment rate would therefore be misleading.
Together, these measures show why “coverage” needs a precise definition. A person may be legally included in a scheme, actively contributing, currently receiving a benefit, or covered by a benefit at the moment a risk occurs. Insurance and microinsurance programs should state which of these conditions they measure when reporting reach.
Insurance market penetration
Insurance market penetration is another useful, but indirect, coverage indicator. The OECD’s Global Insurance Market Trends 2024 reports that insurance premiums written exceeded 10% of GDP in France, the United Kingdom and the United States in 2023. Premiums written indicate the scale of insurance business relative to the economy; they do not show how evenly policies or benefits are distributed across households.
Across 54 reporting jurisdictions, non-life premiums represented 55% of total premiums written on average in 2023. Non-life insurance penetration generally remained below 5% of GDP in the selected jurisdictions. Within non-life business, motor-vehicle insurance premiums exceeded one-third of non-life premiums on average, while accident and health insurance premiums represented 23%.
These figures help put health and protection products into a wider market context. A country can have a sizeable insurance market while still leaving particular services, workers or low-income households underinsured. Conversely, a low premium-to-GDP ratio can reflect limited market development, lower purchasing power, a large public role, or a combination of factors. The reported statistics alone do not identify which explanation applies in a particular jurisdiction.
Microinsurance reach and regional concentration
The Landscape of Microinsurance 2024 reported that microinsurance products covered 344 million people across 37 countries in three regions in 2023. Those reported products generated USD 6.2 billion in written premiums. The number of people covered increased 70% over the three years to 2023, covering the period from 2020 to 2023.
Reported reach is therefore growing, but it remains a partial view of global protection. The figures cover products included in the reporting landscape, the specified countries and the three regions represented. They should not be interpreted as a count of every person with an informal risk-sharing arrangement or every insurance product worldwide.
Regional concentration is especially clear in the Asia-Pacific data. According to Reflections from ICII 2024: Using insurance to strengthen economies, Asia-Pacific held 78% of global microinsurance policies in 2023. At the same time, only 13% of people in Asia-Pacific were covered by microinsurance. A dominant share of reported policies can therefore coexist with a relatively low population coverage rate.
For readers assessing microinsurance performance, the most informative combination is reach, geography, premium volume and the denominator used. The 344 million reported people, USD 6.2 billion in written premiums, 70% three-year increase and 13% Asia-Pacific population coverage answer different questions. Keeping those measures separate helps distinguish market growth from broad protection and avoids treating policy counts, premium totals and population coverage as interchangeable.