2025 Global Monitoring report.

 

The window to 2030, the SDG target year, is closing. Without accelerated and sustained progress, hard-won UHC gains risk being lost. Using revised and improved UHC indicators the 2025 Global Monitoring report presents the latest available UHC data and concludes with a call to shared action.

Related to the financial hardship dimension of UHC:

 • Out-of-pocket (OOP) health spending is voluntary, paid at point of care without risk pooling. In effect, it is what people pay directly from their own income, savings or loans when using health services or buying health products, excluding anything covered by insurance, taxes or reimbursements. It includes costs such as medicines, doctor visits, hospital care and diagnostics. It does not include indirect costs such as transportation, nor the opportunity cost of seeking health care (e.g. lost income) or non-medical expenses such as gym memberships or nutritional supplements. 

• Financial hardship in health occurs when OOP health spending reduces people’s ability to meet basic needs or substantially reduces their ability to afford other goods and services. SDG indicator 3.8.2 is used for global tracking of financial hardship in health. 

• Financial hardship due to OOP health spending: see financial hardship in health definition. Both terms are used interchangeably. 

• Financial protection in health refers to the absence of financial barriers to accessing needed care and lack of financial hardship due to out-of-pocket health spending. Global monitoring using SDG indicator 3.8.2 (original or revised) does not capture financial barriers to access (7). • Basic needs: Reflect sufficient consumption to meet a minimum energy requirement based on food consumption patterns within each country plus a small allowance for nonfood expenditures (8). Poverty lines can represent the cost of meeting basic needs (9). 

• Societal poverty line (SPL) is a hybrid poverty line that combines an absolute level of need (the intercept) with a relative component that rises gradually in line with consumption or income levels (the gradient) (8). The SPL allows for the poverty threshold to vary across countries, essentially allowing for the cost of meeting basic needs to increase with the economic development of societies. This results in a definition of poverty that is more closely aligned with each country’s own assessment of basic needs. As a result, the SPL can be used as a single practical definition of basic needs across countries. It is more easily referred to for a cross-country comparison exercise, compared to using different absolute or relative poverty-line definitions depending on the countries’ level of economic development. Other regional and national methods to define household discretionary budget (defined below) and methods to estimate basic needs exist and are relevant to contextualize findings. For SDG indicator 3.8.2, the SPL is defined in 2017 purchasing power parities and corresponds to whichever is greater: US$ 2.15 (the international absolute poverty line) or US$ 1.15 + 50% of median household consumption expenditure or income net of OOP health spending. The 2021 purchasing power parities will be applied in the 2027 UHC monitoring report (10).

 • Discretionary budget: Total consumption expenditure or income net of the cost of basic needs. People living in poverty have negative discretionary budgets, as their level of consumption expenditure or income is below what is required to meet basic needs. For global monitoring of financial hardship due to out-of-pocket health spending, the revised SDG indicator 3.8.2 relies on the SPL as a measure of the cost of basic needs

. • Revised SDG 3.8.2 – Financial hardship indicator (discretionary budget approach): Proportion of the population with positive out-of-pocket household expenditure on health exceeding 40% of household discretionary budget. The financial hardship indicator can be decomposed into the proportion of the population with impoverishing OOP health spending and the proportion with OOP health spending that is large but non-impoverishing (defined below).

• Impoverishing OOP health spending reduces people’s ability to meet basic needs. Therefore, it classifies any spending by people who cannot afford basic needs as a source of financial hardship. In technical terms, impoverishing OOP health spending is OOP health spending that exceeds 100% of discretionary budget, or spending that leaves people with no discretionary budget once OOP is subtracted from their total budget. The population incurring impoverishing health spending can be divided into two mutually exclusive groups of those further impoverished by OOP health spending and those pushed into poverty (defined below). 

• Large OOP health spending does not impact ability to meet basic needs but substantially reduces people’s ability to consume other goods and services. Under the revised SDG 3.8.2 indicator, this refers to the share of the population whose OOP health spending exceeds 40% but remains below 100% of their discretionary budget. 

• Further impoverished by OOP health spending: People who are further impoverished are people who would be poor regardless of whether they incur OOP health spending, yet such spending further reduces their ability to meet basic needs. Under the revised SDG 3.8.2 indicator, the proportion further impoverished corresponds to those who live below the societal poverty line and incur any OOP health spending, as a share of the total population. These are people with negative discretionary budgets, and therefore any positive OOP health spending is above 40% of the discretionary budget. 

• Pushed into poverty by OOP health spending: Under the revised SDG 3.8.2 indicator, the proportion pushed into poverty corresponds to the share of the total population who do not live in societal poverty, based on their total consumption (or income), but whose consumption (or income) falls below the SPL when net of OOP health spending. In other words, these are people living in households that have positive discretionary budgets and spend all of their discretionary budget on OOP health spending.

 • Original SDG 3.8.2 – Catastrophic out-of-pocket health spending indicator (budget share approach): Proportion of the population with OOP health spending exceeding 10% and 25% of household total budget (consumption expenditure or income)