The goal of universal health coverage is to provide access to quality health services for everyone, regardless of their economic or social status. The OECD monitors and evaluates key aspects of universal health coverage, and assesses the future sustainability of universal health systems. OECD country experiences can also offer valuable lessons for other countries seeking to attain universal health coverage. While many countries already offer all their citizens affordable access to a comprehensive package of health services, they face challenges in sustaining these systems, especially in the current economic climate.
Health inequality and universal health coverage
Access to high-quality care for the whole population, irrespective of their socio-economic circumstances, is a fundamental principle underpinning all health systems across OECD countries. Still, large inequalities in health status and life expectancy persist. These should be urgently addressed to ensure people have access to the care they need to live happy and productive lives.
Key messages
Strengthening primary healthcare is key to achieving UHC and increasing health system resilience. The main reason cited for unmet needs for medical care across OECD countries was waiting times, followed by cost and distance to travel. Policies therefore need to ensure an adequate supply and distribution of health workers and healthcare services, as well as address any financial barriers that may prevent people getting the care they need.
Those living in deprived areas, the migrant population, and ethnic minorities are at higher risk of catching and dying from the virus than other groups. At the same time, mental health and routine care are struggling to recover to their pre-pandemic levels in many countries, disproportionately impacting those with chronic diseases or multiple health challenges. In order to address the root causes of health inequalities, countries should address the social determinants of health and look at other areas, such as social and housing policies.
Context
Population health coverage
Most OECD countries have achieved universal or near-universal coverage for a core set of health services, which usually include consultations with doctors, tests and examinations, and hospital care.
Population coverage for core services remained below 95% in four OECD countries in 2024, and was below 90% in Mexico. In the United States, the share of uninsured people decreased following the Affordable Care Act, from about 13% in 2013 to 9% in 2015, with a more gradual reduction in uninsured people since then. Uninsured people tend to be working-age adults with lower education or income levels.
Unmet needs for medical care
In all OECD countries analysed, socio‑economic disparities are significant. The burden of unmet needs for medical care falls disproportionally more on people in the lowest income group than those in the highest income group. People in the lowest income quintile were 2.5 times more likely to report unmet medical care needs than those in the highest quintile in 2024, on average across 28 OECD countries.
The income gradient was largest in Greece, Latvia and Finland, with a difference of over 8 p.p. in the population reporting unmet needs between the lowest and highest income quintiles. In Greece, more than one in six people in the lowest income quintile reported unmet medical care needs, and in Estonia, Finland and Latvia this proportion reaches more than one in ten people in the lowest income quintile.
Access to primary care doctors
Consultations with primary care doctors are for many people the most frequent contact with healthcare services, and often provide an entry point for medical treatment. Having enough General Practitioners (GPs) or family doctors available is a crucial factor in ensuring people can access the care they need in a timely manner.
However, GPs represented about one‑fifth (21%) of all doctors on average across OECD countries in 2023. This share ranged from over one‑third in Canada, Finland and Belgium to just 6% of all doctors in Greece and Korea.
