TOP 10 Countries by Out-of-Pocket Health Spending Share (2025)
Which Countries Rely Most on Out-of-Pocket Health Payments?
Armenia had the highest reported out-of-pocket health spending share in the WHO/World Bank 2025 data release, at 80.47% of current health expenditure. Bangladesh ranked second at 79.31%, followed by Turkmenistan at 77.39%. These are 2023 observations published through the 2025 Global Health Expenditure Database release, not projected 2025 values.
Metric: household out-of-pocket payments as a percentage of current health expenditure. Source mode: one official WHO Global Health Expenditure Database indicator series, distributed through World Bank WDI. Source count: 1 underlying indicator series. Coverage: 10 confirmed countries. Unit: % of CHE. Direction: higher share ranks higher. Status: 10 official_value rows, with no calculated values, official forecasts or modeled projections.
Armenia ranks first in the confirmed global Top 10.
Equatorial Guinea ranks tenth; this is the Top 10 cutoff, not the global minimum.
All ten observations are for 2023 in the GHED release updated in December 2025.
10 official published values from the WHO/World Bank indicator series.
What out-of-pocket health spending share measures
The WHO indicator OOP%CHE measures the share of current health expenditure funded directly by household out-of-pocket payments. Its measurement basis is household out-of-pocket payment (HF.3) divided by current health expenditure (CHE).
How to read it: an OOP share of 80% means household out-of-pocket payments finance roughly four-fifths of recorded current health expenditure. It does not mean that the average person spends 80% of income on healthcare.
The remainder of current health expenditure is financed through government, external and other non-OOP financing sources and arrangements recorded in the health accounts. WHO notes that high reliance on direct household payments is associated with greater exposure to catastrophic and impoverishing health spending.
OOP%CHE is a financing-structure indicator. It is different from out-of-pocket spending per person, total health expenditure, catastrophic health spending and the number of people who forgo care because they cannot afford or access it.
Top five countries at a glance
Four countries exceed 77%: Armenia, Bangladesh, Turkmenistan and Afghanistan. The largest adjacent gap in the Top 10 is between Afghanistan at 77.14% and the Syrian Arab Republic at 72.40%.
Top five countries by OOP expenditure share, 2023 observations
| Rank | Entity | Value | Region / source note |
|---|---|---|---|
| 1 | Armenia | 80.47% | Europe & Central Asia; 2023; WHO GHED via WDI; official_value. |
| 2 | Bangladesh | 79.31% | South Asia; 2023; WHO GHED via WDI; official_value. |
| 3 | Turkmenistan | 77.39% | Europe & Central Asia; 2023; WHO GHED via WDI; official_value. |
| 4 | Afghanistan | 77.14% | South Asia; 2023; WHO GHED via WDI; official_value. |
| 5 | Syrian Arab Republic | 72.40% | Middle East & North Africa; 2023; WHO GHED via WDI; official_value. |
Rank is calculated directly from the raw OOP%CHE values in descending order.
Chart: Top 10 countries by out-of-pocket health spending share
Bars use the metric's natural 0–100% scale and match the raw values in the ranking table.
Methodology
The ranking uses World Bank indicator SH.XPD.OOPC.CH.ZS, sourced from the World Health Organization Global Health Expenditure Database. The World Bank identifies the GHED source series as updated on December 12, 2025. Every Top 10 value used here is a 2023 observation.
Metric and unit
Out-of-pocket expenditure as a percentage of current health expenditure. Unit: %. Higher values rank higher.
Official measurement basis
WHO defines the indicator as household out-of-pocket payment (HF.3) divided by current health expenditure (CHE).
Year logic
Snapshot: 2025 GHED release. Observation year: 2023 for all ten rows. No 2025 value is projected or inferred.
Ranking method
Country values are sorted from highest to lowest using the raw published percentage. World, regional and income-group aggregates are excluded.
Value status
All ten entries are official_value because the displayed percentages are published directly in the WHO/World Bank indicator series.
Official-data caveat
Official_value does not imply that every underlying input is an unadjusted administrative observation. WHO may use estimates where necessary to improve completeness and consistency across countries and years.
Regional classification
Regional labels follow World Bank geographic groupings: Europe & Central Asia, South Asia, Middle East & North Africa, Sub-Saharan Africa, and East Asia & Pacific.
Missing values and limits
No missing value is imputed and no conflicting source is averaged. OOP%CHE does not measure healthcare prices, spending per person, unmet need, healthcare quality or catastrophic-spending prevalence.
Main ranking: Top 10 countries by out-of-pocket health spending share
All ranking values are 2023 observations.
Top 10 countries by OOP expenditure as a share of current health expenditure
| Rank | Entity | Value | Source / method note |
|---|---|---|---|
| 1 | Armenia | 80.47% | WHO GHED via WDI; 2023; official_value; Europe & Central Asia. |
| 2 | Bangladesh | 79.31% | WHO GHED via WDI; 2023; official_value; South Asia. |
| 3 | Turkmenistan | 77.39% | WHO GHED via WDI; 2023; official_value; Europe & Central Asia. |
| 4 | Afghanistan | 77.14% | WHO GHED via WDI; 2023; official_value; South Asia. |
| 5 | Syrian Arab Republic | 72.40% | WHO GHED via WDI; 2023; official_value; Middle East & North Africa. |
| 6 | Nigeria | 71.90% | WHO GHED via WDI; 2023; official_value; Sub-Saharan Africa. |
| 7 | Myanmar | 71.13% | WHO GHED via WDI; 2023; official_value; East Asia & Pacific. |
| 8 | Yemen, Rep. | 69.13% | WHO GHED via WDI; 2023; official_value; Middle East & North Africa. |
| 9 | Cameroon | 67.65% | WHO GHED via WDI; 2023; official_value; Sub-Saharan Africa. |
| 10 | Equatorial Guinea | 65.98% | WHO GHED via WDI; 2023; official_value; Sub-Saharan Africa. |
Aggregate groups are excluded. No missing value is imputed, no conflict is averaged and no forecast is used.
Insights from the Top 10
Key Insight
Every country in the Top 10 finances more than 65% of current health expenditure through household out-of-pocket payments. Armenia leads at 80.47%.
Notable Pattern
The top four form a tight cluster above 77%. Only 3.33 percentage points separate Armenia in first place from Afghanistan in fourth.
Regional / Source Concentration
Sub-Saharan Africa contributes three Top 10 countries: Nigeria, Cameroon and Equatorial Guinea. All ten values come from the same WHO GHED indicator series.
Outlier
The largest adjacent rank gap is 4.74 percentage points, between Afghanistan at 77.14% and the Syrian Arab Republic at 72.40%.
How to interpret a high OOP share
A high rank means direct household payments account for a large share of recorded current health expenditure. It does not mean residents necessarily pay more dollars for healthcare than residents of countries with lower OOP shares.
WHO treats OOP%CHE as a health-financing indicator and notes that high reliance on direct household payments is associated with greater risk of catastrophic and impoverishing health spending. Financial hardship itself is measured with separate household-level indicators.
The ranking also does not capture people who need care but do not obtain it because of cost or access barriers. Low spending can coexist with unmet healthcare need, so OOP%CHE should not be read as a complete measure of financial protection or healthcare access.
Cross-country comparisons should also account for how national health accounts are compiled. WHO works with Member States using health accounts, government expenditure records and official statistics and may use estimates where necessary to improve completeness and consistency across countries and years.
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Download Excel + CSV Data PackFAQ
Which country has the highest out-of-pocket health spending share in this snapshot?
Armenia ranks first at 80.47% of current health expenditure, followed by Bangladesh at 79.31% and Turkmenistan at 77.39%.
Are these 2025 health-spending observations?
No. This is a 2025 GHED release snapshot using 2023 observations. The ranking does not project values forward to 2025.
What does OOP%CHE mean?
It is the share of current health expenditure funded from household out-of-pocket payments. WHO measures it as household OOP payment (HF.3) divided by current health expenditure (CHE).
Are the ranking values officially published?
Yes. The displayed percentages are published in the WHO GHED series and distributed through World Bank WDI. WHO may use estimates where necessary to improve completeness and consistency across countries and years.
Does a higher OOP share mean healthcare is more expensive?
No. The indicator measures the financing mix, not healthcare prices or spending per person.
Is OOP share the same as catastrophic health spending?
No. OOP%CHE measures the share of national current health expenditure financed directly by households. Catastrophic health-spending indicators measure the burden of health payments on household budgets.
Can a low OOP share prove that people have good access to care?
No. OOP%CHE does not measure unmet need. People who cannot afford or access care may spend little because they do not receive treatment.
Why are WHO and World Bank both listed?
WHO GHED is the underlying official health-expenditure source. World Bank WDI distributes the indicator through its comparable country data series used here to verify ranking order.
Sources
World Bank Data — Out-of-pocket expenditure (% of current health expenditure)
Used to verify country values, observation years, ranking order and indicator code SH.XPD.OOPC.CH.ZS.
https://data.worldbank.org/indicator/SH.XPD.OOPC.CH.ZS?most_recent_value_desc=true
WHO Global Health Expenditure Database
Underlying official health-expenditure source for the indicator and the December 2025 release providing 2023 observations.
WHO Indicator Metadata — OOP%CHE
Primary reference for the indicator definition, HF.3/CHE measurement basis, rationale and interpretation limits.
