Advanced Economies on Average With Lower Share of Out-Of-Pocket Spending in Health Expenditure

According to the Global Health Expenditure Database by the World Health Organization (WHO), the global average out-of-pocket expenses related to health across 192 countries made up 30 percent of all health expenditures per capita in 2022. This type of spending includes over-the-counter medicine, health aids or, as is the case for the U.S. healthcare system, deductibles or co-pays. While most high and upper-middle-income countries have a lower share of out-of-pocket spending due to nonprofit schemes, government transfers, and comprehensive social health insurance, this type of spending makes up two-thirds or more of all health spending in thirteen countries and territories.

Among this group are Turkmenistan, Armenia, Afghanistan and Nigeria, each exhibiting an out-of-pocket spending share of more than 75 percent. The United States, which is the only advanced economy with no robust universal health coverage, has a share of eleven percent. Looking at absolute instead of relative numbers, overall out-of-pocket spending grew to $471 billion or around $1,400 per capita according to the NHE fact sheet published by the Centers for Medicaid & Medicare Services. Private health insurance spending in the United States constituted 29 percent of national health expenditure, amounting to $1.3 trillion.

A comparison between the United States and other leading economies reveals that the U.S. has the same relative level of out-of-pocket spending as Germany and Japan as well as two percent less than the United Kingdom and two percent more than France. China, the second-biggest economy after the United States, exhibits an out-of-pocket spending share of 34 percent, despite almost universal healthcare coverage. This is likely due to a lower level of benefits, necessitating covering larger health expenses with personal money.