Top 100 Countries by Out-of-Pocket Health Spending, 2026
How much of national health spending households pay directly
This page compares 100 countries and economies by the most recent reported share of health expenditure financed through household out-of-pocket payments. The indicator is a percentage, not a dollar amount and not spending per person. A value of 60% means that direct household payments account for 60% of the health spending recorded for that location in the reported year.
The figures come from the World Health Organization Global Health Expenditure Database and are distributed through World Bank World Development Indicators under code SH.XPD.OOPC.CH.ZS. The source release was updated on December 12, 2025, and the table was compiled on July 11, 2026.
The 2026 title refers to the date of this comparison. It uses reported observations, mainly from 2023, rather than projected 2026 figures.
Armenia has the highest figure in the table.
World Bank world aggregate for 2023.
Calculated from the 50th and 51st values.
Madagascar is the final entry in this selection.
Key findings from the data
Sixteen entries exceed 60%
Armenia, Bangladesh, Turkmenistan and Afghanistan are all above 77%. At these levels, direct household payments account for most of the recorded financing of health services and goods.
The entire table is above the world figure
The World Bank world aggregate is 17.33% for 2023. Even the 100th entry, Madagascar at 27.42%, is about ten percentage points higher.
Several regions are strongly represented
Sub-Saharan Africa contributes 31 entries, Europe and Central Asia 22, Latin America and the Caribbean 18, the Middle East and North Africa 13, East Asia and the Pacific 10, and South Asia 6. These are counts within this table, not regional averages.
Reporting years are not identical
Ninety-five rows use 2023 observations, four use 2024, and Ukraine is represented by a 2021 figure. The table therefore compares the most recent reported number for each location rather than one common year.
Important interpretation: a higher share generally points to less pooling of health costs and greater direct exposure for households. It is not, however, a complete measure of affordability, quality, access or health outcomes.
Full table of 100 countries and economies
Search by name, filter by region or change the number of visible rows; the original global positions remain unchanged.
Showing 100 countries and economies.
Positions are based on source values before rounding to two decimals.
| Rank | Country or economy | Household-paid share | Observation year and region |
|---|---|---|---|
| 1 | Armenia | 80.47% | 2023 Europe & Central Asia |
| 2 | Bangladesh | 79.31% | 2023 South Asia |
| 3 | Turkmenistan | 77.39% | 2023 Europe & Central Asia |
| 4 | Afghanistan | 77.14% | 2023 South Asia |
| 5 | Syria | 72.40% | 2023 Middle East & North Africa |
| 6 | Nigeria | 71.90% | 2023 Sub-Saharan Africa |
| 7 | Myanmar | 71.13% | 2023 East Asia & Pacific |
| 8 | Yemen | 69.13% | 2023 Middle East & North Africa |
| 9 | Cameroon | 67.65% | 2023 Sub-Saharan Africa |
| 10 | Equatorial Guinea | 65.98% | 2023 Sub-Saharan Africa |
| 11 | Azerbaijan | 64.63% | 2023 Europe & Central Asia |
| 12 | Togo | 64.34% | 2023 Sub-Saharan Africa |
| 13 | Uzbekistan | 64.06% | 2023 Europe & Central Asia |
| 14 | Liberia | 63.24% | 2023 Sub-Saharan Africa |
| 15 | Tajikistan | 62.36% | 2023 Europe & Central Asia |
| 16 | Guinea-Bissau | 61.56% | 2023 Sub-Saharan Africa |
| 17 | Cambodia | 60.60% | 2023 East Asia & Pacific |
| 18 | Nepal | 59.39% | 2023 South Asia |
| 19 | Georgia | 58.76% | 2023 Europe & Central Asia |
| 20 | Sudan | 57.37% | 2023 Sub-Saharan Africa |
| 21 | Egypt | 57.20% | 2023 Middle East & North Africa |
| 22 | Guatemala | 57.18% | 2023 Latin America & Caribbean |
| 23 | Comoros | 56.57% | 2023 Sub-Saharan Africa |
| 24 | Sri Lanka | 54.81% | 2023 South Asia |
| 25 | Sierra Leone | 54.47% | 2023 Sub-Saharan Africa |
| 26 | Guinea | 54.42% | 2023 Sub-Saharan Africa |
| 27 | Iraq | 53.98% | 2023 Middle East & North Africa |
| 28 | Honduras | 53.06% | 2023 Latin America & Caribbean |
| 29 | Pakistan | 52.93% | 2023 South Asia |
| 30 | Haiti | 52.40% | 2023 Latin America & Caribbean |
| 31 | Chad | 51.68% | 2023 Sub-Saharan Africa |
| 32 | Niger | 51.48% | 2023 Sub-Saharan Africa |
| 33 | Barbados | 49.49% | 2023 Latin America & Caribbean |
| 34 | Mongolia | 48.80% | 2023 East Asia & Pacific |
| 35 | Grenada | 48.48% | 2023 Latin America & Caribbean |
| 36 | Eritrea | 48.45% | 2023 Sub-Saharan Africa |
| 37 | Albania | 48.27% | 2023 Europe & Central Asia |
| 38 | Mali | 47.23% | 2023 Sub-Saharan Africa |
| 39 | Ethiopia | 46.27% | 2023 Sub-Saharan Africa |
| 40 | Ukraine | 45.29% | 2021 Europe & Central Asia |
| 41 | Trinidad and Tobago | 45.27% | 2023 Latin America & Caribbean |
| 42 | Mauritius | 45.24% | 2023 Sub-Saharan Africa |
| 43 | Central African Republic | 45.02% | 2023 Sub-Saharan Africa |
| 44 | Algeria | 45.00% | 2023 Middle East & North Africa |
| 45 | Laos | 44.84% | 2023 East Asia & Pacific |
| 46 | Philippines | 44.36% | 2023 East Asia & Pacific |
| 47 | Senegal | 44.33% | 2023 Sub-Saharan Africa |
| 48 | India | 43.89% | 2023 South Asia |
| 49 | Burkina Faso | 43.82% | 2023 Sub-Saharan Africa |
| 50 | Mauritania | 43.77% | 2023 Sub-Saharan Africa |
| 51 | Iran | 43.15% | 2023 Middle East & North Africa |
| 52 | Benin | 42.41% | 2023 Sub-Saharan Africa |
| 53 | Kyrgyzstan | 42.26% | 2023 Europe & Central Asia |
| 54 | West Bank and Gaza | 42.07% | 2023 Middle East & North Africa |
| 55 | Saint Kitts and Nevis | 41.80% | 2023 Latin America & Caribbean |
| 56 | Mexico | 41.24% | 2023 Latin America & Caribbean |
| 57 | Panama | 40.46% | 2023 Latin America & Caribbean |
| 58 | North Macedonia | 39.57% | 2023 Europe & Central Asia |
| 59 | Viet Nam | 39.20% | 2023 East Asia & Pacific |
| 60 | Chile | 39.15% | 2024 Latin America & Caribbean |
| 61 | Democratic Republic of the Congo | 38.00% | 2023 Sub-Saharan Africa |
| 62 | Tunisia | 37.94% | 2023 Middle East & North Africa |
| 63 | Nicaragua | 37.63% | 2023 Latin America & Caribbean |
| 64 | Morocco | 37.25% | 2023 Middle East & North Africa |
| 65 | Saint Lucia | 37.14% | 2023 Latin America & Caribbean |
| 66 | Malaysia | 37.09% | 2023 East Asia & Pacific |
| 67 | Paraguay | 36.32% | 2023 Latin America & Caribbean |
| 68 | Bulgaria | 35.50% | 2023 Europe & Central Asia |
| 69 | Latvia | 35.06% | 2023 Europe & Central Asia |
| 70 | Jordan | 34.47% | 2023 Middle East & North Africa |
| 71 | Greece | 34.30% | 2023 Europe & Central Asia |
| 72 | Gambia | 33.78% | 2023 Sub-Saharan Africa |
| 73 | South Korea | 33.74% | 2024 East Asia & Pacific |
| 74 | Angola | 32.55% | 2023 Sub-Saharan Africa |
| 75 | El Salvador | 32.49% | 2023 Latin America & Caribbean |
| 76 | China | 32.17% | 2023 East Asia & Pacific |
| 77 | Uganda | 32.17% | 2023 Sub-Saharan Africa |
| 78 | Serbia | 32.14% | 2023 Europe & Central Asia |
| 79 | Cote d'Ivoire | 31.99% | 2023 Sub-Saharan Africa |
| 80 | Lithuania | 31.43% | 2024 Europe & Central Asia |
| 81 | Indonesia | 31.08% | 2023 East Asia & Pacific |
| 82 | Bosnia and Herzegovina | 30.96% | 2023 Europe & Central Asia |
| 83 | Malta | 30.93% | 2023 Europe & Central Asia |
| 84 | Ecuador | 30.89% | 2023 Latin America & Caribbean |
| 85 | Somalia | 30.78% | 2023 Sub-Saharan Africa |
| 86 | Lebanon | 29.70% | 2023 Middle East & North Africa |
| 87 | Venezuela | 29.69% | 2023 Latin America & Caribbean |
| 88 | Dominica | 29.33% | 2023 Latin America & Caribbean |
| 89 | Djibouti | 28.84% | 2023 Middle East & North Africa |
| 90 | Bahrain | 28.66% | 2023 Middle East & North Africa |
| 91 | Belarus | 28.48% | 2023 Europe & Central Asia |
| 92 | Russia | 28.39% | 2023 Europe & Central Asia |
| 93 | Portugal | 28.19% | 2024 Europe & Central Asia |
| 94 | Congo | 27.97% | 2023 Sub-Saharan Africa |
| 95 | Seychelles | 27.96% | 2023 Sub-Saharan Africa |
| 96 | Tanzania | 27.93% | 2023 Sub-Saharan Africa |
| 97 | Kazakhstan | 27.64% | 2023 Europe & Central Asia |
| 98 | Bahamas | 27.48% | 2023 Latin America & Caribbean |
| 99 | Moldova | 27.47% | 2023 Europe & Central Asia |
| 100 | Madagascar | 27.42% | 2023 Sub-Saharan Africa |
The table includes locations with a reported numeric figure in the World Bank series and excludes regional and income-group aggregates. “West Bank and Gaza” is retained because it is listed as an economy by the World Bank. Region names follow World Bank geographic groupings.
What out-of-pocket health spending means
Out-of-pocket health expenditure is the portion of health spending paid directly by households. It can include payments for consultations, medicines, diagnostic tests, hospital services, dental care and other health goods or services that are not fully reimbursed by a public programme, compulsory insurance, voluntary insurance, an employer or another third-party payer.
The percentage is calculated by dividing household out-of-pocket payments by total spending on health goods and services during the year. Capital investment, such as hospital construction or major equipment purchases, is not included. Because the indicator is a ratio, the percentage can change when government, insurance or donor funding changes, even if household payments remain similar.
A higher percentage usually indicates that less of the system’s costs are pooled before care is used. Pooling spreads financial risk across a wider population. When households must pay a large share directly, people with serious or recurring medical needs can face greater financial pressure than healthier households.
WHO links high direct payments with a greater risk of catastrophic and impoverishing medical costs. The percentage does not, however, show how many families cross a catastrophic-spending threshold. That requires separate household-level indicators comparing medical payments with income, consumption or capacity to pay.
The measure also differs from out-of-pocket spending per person. A high-income country can have a lower percentage but a much higher dollar amount per resident because its overall health system is larger. A lower-income country may show a very high percentage even when the amount spent per person is comparatively small. The table therefore describes how health care is financed, not the average size of a medical bill.
Example: Bangladesh’s 79.31% means that direct household payments represented 79.31% of recorded health expenditure in its reported year. It does not mean that every household spent 79.31% of its income on medical care.
Why household-paid shares differ between countries
Public financing and compulsory insurance
Countries that fund more care through taxation, social insurance or other compulsory arrangements usually record a lower direct household share. The result depends on which services, medicines and population groups are covered.
Benefits and patient charges
Insurance may cover hospital treatment while leaving medicines, outpatient visits, dental care or diagnostic services partly unpaid. Copayments, deductibles, reimbursement limits and exclusions can keep household costs high even where most residents have insurance.
Medicine coverage
Medicines are a major source of direct payment in many health systems. Limited public formularies, weak reimbursement, high retail prices or reliance on private pharmacies can substantially increase the household burden.
Use of private providers
A large private outpatient or hospital sector can increase direct payments when public capacity is limited, waiting times are long or patients prefer private services. The effect depends on whether private treatment is reimbursed.
External assistance
Donor financing may support vaccination, infectious-disease programmes, maternal health or other services. A rise or fall in external funding can change the percentage even when household behaviour changes little.
Conflict and service disruption
Conflict can weaken public financing, interrupt insurance systems and push patients toward private or informal care. It may also reduce the use and recording of services, making the figures harder to interpret.
Informal and unrecorded payments
Health accounts attempt to capture household spending, but informal payments and fragmented private markets are difficult to measure consistently. Survey quality and administrative records influence cross-country comparability.
Changes in total spending
The share can fall because government or insurance expenditure rises, even if households continue to pay the same amount. It can increase when pooled funding contracts. Looking at trends over several years provides more context than one annual percentage.
Within this table, the median for South Asia is 57.10%. The corresponding medians are 45.24% for Sub-Saharan Africa, 42.07% for the Middle East and North Africa, 41.78% for East Asia and the Pacific, 39.80% for Latin America and the Caribbean, and 35.28% for Europe and Central Asia. These figures describe only the locations included in the table, not every member of each region.
How the table was prepared
Indicator
Out-of-pocket expenditure as a percentage of health spending, World Bank code SH.XPD.OOPC.CH.ZS.
Data source
WHO Global Health Expenditure Database, published through World Bank World Development Indicators. Our World in Data was consulted for additional metadata.
Selection method
The most recent reported figure was selected for each location. Regional and income-group aggregates were removed, and the 100 highest percentages were retained.
Reporting period
The table contains observations from 2021 to 2024. Most entries use 2023 data.
Positions are calculated from the precision available in the source before percentages are rounded for display. This matters when two figures appear equal. China and Uganda both show 32.17%, for example, but their underlying source values differ beyond the two decimal places displayed.
Region names follow World Bank geographic groupings rather than WHO regions. Counts and regional medians are calculated from the 100 rows shown on this page.
WHO prepares international health-expenditure data within the System of Health Accounts 2011 framework. Published figures can combine national health accounts, administrative records, surveys and harmonized estimates. They should not automatically be treated as unadjusted national observations in every case.
Locations without a reported figure were excluded. The median and regional summaries are calculated from the entries displayed in the table.
Top 20 on a 0–100% scale
Each bar corresponds directly to the reported percentage. Armenia’s bar fills 80.47% of the scale, while Sudan’s fills 57.37%.
Limits of the comparison
- Years are not identical. Using the most recent figure improves coverage but reduces strict same-year comparability. A 2021 observation may no longer reflect current conditions.
- The indicator is a percentage, not an amount. It does not report dollars per person, household income spent on care or the price of a standard treatment.
- It does not measure quality or outcomes. The table cannot show clinical quality, waiting times, life expectancy, avoidable mortality or patient satisfaction.
- It does not directly measure unmet need. Households that cannot afford treatment may spend little because they delay or avoid care.
- It is not a catastrophic-spending rate. Separate household-level indicators are needed to estimate how many families face medical payments that threaten their living standards.
- Data systems vary. Countries differ in the frequency and quality of health accounts, household surveys, private-sector reporting and estimation inputs.
- Small differences in position may not be meaningful. Countries separated by only a few hundredths of a percentage point can have broadly similar financing structures.
Use the table together with spending per person, government health expenditure, insurance coverage, catastrophic-spending rates, service-use data and health outcomes when evaluating a national health system.
Questions about direct household health spending
Does a higher percentage mean health care is more expensive?
Not necessarily. The percentage shows how health care is financed. It can be high because government and insurance funding is limited, even when the dollar amount paid per person is lower than in wealthier countries.
Does a low percentage prove that care is affordable?
No. A low share may reflect strong public or insurance funding, but it can coexist with waiting times, limited availability, high prices for particular treatments or unmet need among people who do not obtain care.
Why is the world figure lower than every entry in the table?
The table intentionally includes the 100 highest reported percentages. The world aggregate of 17.33% for 2023 also reflects countries with much lower household-paid shares.
Are these projected 2026 values?
No. The page was prepared in 2026 using reported observations from 2021 to 2024.
Why are some observations from different years?
Health-expenditure reporting schedules vary. The observation year is displayed in every row so readers can identify older figures.
Are all figures raw national statistics?
Not necessarily. WHO prepares the series using national health accounts, administrative records, surveys and harmonized estimates under the System of Health Accounts 2011 framework.
Why can two countries with the same displayed percentage have different positions?
The ordering uses the precision available in the source before percentages are rounded to two decimal places.
Is the 100th entry the lowest worldwide?
No. Madagascar’s 27.42% is the cutoff for this table. Locations with lower percentages are not displayed.
Data sources
World Bank indicator
Values, observation years, source attribution and downloadable data.
World Bank: out-of-pocket expenditure as a share of health spending
WHO Global Health Expenditure Database
The primary international database used for the health-financing figures.
WHO indicator metadata
Definition, formula, unit and System of Health Accounts 2011 context.
Our World in Data
Additional notes on the indicator, downloadable data and methodology.
Our World in Data: share of out-of-pocket spending on health care
Download the World Bank series: SH.XPD.OOPC.CH.ZS in Excel format.
