TOP 10 Countries by Health Expenditure as a Share of GDP (2025)

by admin November 18, 2025 1409 19 min read

This section looks at the countries that devote the highest share of their economy to health. The metric is current health expenditure as a percentage of GDP, based on the World Bank and WHO System of Health Accounts. It captures recurrent spending on hospitals, primary care, medicines and other services, but excludes capital investment such as hospital buildings and major equipment.

Using the latest available data (mostly 2021–2022), the ranking reveals a mixed group of countries. It includes:

High-income health systems such as the United States, Germany, Canada, France and Austria, where population ageing, high wages for medical professionals and advanced technologies push spending up.
Small island states such as Tuvalu and Palau, where small populations and the need to import specialized care result in very high spending relative to GDP.
Fragile and low-income economies like Afghanistan and Liberia, where a combination of disease burden, donor-financed programs and limited GDP inflates the spending-to-GDP ratio.

Key point: a high share of GDP spent on health does not automatically mean better outcomes. It often reflects a mix of demographic pressures, prices, system inefficiencies and the relative size of the economy.

Top 10 countries by health expenditure as a share of GDP

The table below uses the latest available World Bank / WHO data compiled by international databases. Values are rounded to one decimal place.

Rank	Country	Health expenditure (% of GDP, latest year)
1	Afghanistan	21.5%
2	Tuvalu	19.6%
3	United States	17.5%
4	Palau	14.6%
5	Liberia	13.8%
6	Germany	12.9%
7	Canada	12.4%
8	Armenia	12.3%
9	France	12.3%
10	Austria	12.2%

For comparison, the global average health expenditure is roughly 10% of world GDP, meaning all of the countries above spend well above the global norm on health as a share of economic output.

Why do these countries spend such a large share of GDP on health?

High health expenditure as a share of GDP can arise from several combinations of factors:

Demographics and disease burden. Older populations, a high prevalence of chronic diseases or post-conflict health needs all raise demand for care.
Prices and wages. In advanced economies like the United States, Germany and France, highly paid medical staff, expensive medicines and advanced technologies push up costs.
System design and incentives. Fee-for-service payment, fragmented insurance markets and hospital-centric care tend to increase spending, especially when weak regulation allows over-provision or high mark-ups.
GDP denominator effects. In countries with low GDP per capita or sharp economic contractions, even moderate health spending can produce a very high percentage of GDP.

This helps explain why Afghanistan and Liberia appear alongside rich OECD members. In the former, limited GDP, high donor support and substantial out-of-pocket payments lift the ratio. In the latter, ageing populations and high unit costs drive up spending despite far higher incomes.

Analytical reading: when comparing countries, the key is not just how much they spend, but who pays, how efficiently the money is used, and whether households are protected from catastrophic costs.

Table 2. Public and private financing shares (approximate, latest available data)

The table below shows the indicative split between public and private funding of current health expenditure. Public financing includes government and compulsory social health insurance; private financing aggregates voluntary insurance, employer schemes, households’ out-of-pocket spending and other private sources. Values are rounded to the nearest 5 percentage points.

Country	Public financing (% of current health expenditure)	Private financing (% of current health expenditure)
Afghanistan	~20%	~80%
Tuvalu	~65%	~35%
United States	~55%	~45%
Palau	~60%	~40%
Liberia	~35%	~65%
Germany	~75%	~25%
Canada	~70%	~30%
Armenia	~55%	~45%
France	~80%	~20%
Austria	~75%	~25%

Advanced European systems cluster at around three-quarters public funding, reflecting tax-financed or social insurance models with strong financial protection. The United States stands out with the highest share of GDP spent on health, but with a much larger private component. Afghanistan and Liberia illustrate the opposite challenge: high spending relative to GDP combined with heavy private and out-of-pocket reliance.

Chart 1. Health expenditure (% of GDP) — TOP 10 vs world average

The chart compares the TOP 10 countries with the approximate world average of about 10% of GDP. It highlights just how far these systems sit above the global benchmark.

Who actually pays? Government, private insurance and out-of-pocket

Looking only at the share of GDP can hide crucial differences in who finances health care. Three contrasting examples illustrate this:

Afghanistan combines very high health spending as a share of GDP with predominantly out-of-pocket payments. Many households pay directly for medicines, consultations and diagnostics, creating a high risk of catastrophic health expenditure.
The United States spends more of its GDP on health than any other large economy, but financing is split between public programs (Medicare, Medicaid, VA), private insurance and substantial out-of-pocket charges. Coverage gaps and high cost-sharing mean that financial protection is incomplete.
Germany is closer to the typical Western European social insurance model: a large public and social insurance component, modest voluntary insurance and relatively low out-of-pocket spending, which helps limit financial hardship.

Policy implication: For low- and middle-income countries, raising the public share of health spending is as important as increasing total spending. For high-income systems, the challenge is often to improve efficiency and equity rather than simply spend more.

Chart 2. Structure of health financing — government, private and out-of-pocket (illustrative)

The chart below uses illustrative breakdowns based on WHO Global Health Expenditure Database and OECD patterns for the most recent years. Values are rounded and intended to show the contrast between models, not to replace country-level statistics.

What the 2025 snapshot tells us

Together, the tables and charts show that:

Some low-income and fragile states spend an exceptionally high share of GDP on health, yet rely heavily on donors and out-of-pocket payments. The risk of financial hardship remains acute.
A group of advanced economies sits well above the global average, but outcomes vary. High spending can coexist with significant inefficiencies and inequities, especially where coverage is fragmented.
The composition of financing is as important as the level. Systems that combine strong public or social insurance funding with relatively low out-of-pocket burdens tend to offer better financial protection and more predictable access to care.

In the next decade, health policy debates in high-spending countries are likely to focus on efficiency, value for money and workforce sustainability, whereas in low- and middle-income settings the priority will be to expand fiscal space, reduce out-of-pocket spending and move toward universal health coverage.