Countries by Risk of catastrophic expenditure for surgical care (% of people at risk)

Cote d'Ivoire ranks first with 100% of its population at risk of catastrophic expenditure for surgical care, meaning the entire population faces potential financial ruin if surgery is needed. At the other end, eleven countries including Germany, Norway, Sweden, and the United Kingdom record 0%, indicating negligible financial risk. The gap between these extremes spans the full range of the metric and reflects stark differences in how surgical costs fall on individuals.

Population & Health category

Ranking 2022

Values shown in %.

Countries by Risk of catastrophic expenditure for surgical care (% of people at risk)
Rank	Country	%
1	Côte d'Ivoire	100.00
2	Burundi	97.80
3	Yemen	93.40
4	Latvia	89.90
5	Syria	87.50
6	Guinea-Bissau	86.50
7	Niger	86.30
8	DR Congo	85.00
9	Sierra Leone	84.30
10	Chad	82.40
11	Estonia	78.30
12	Togo	72.40
13	Mauritania	69.10
14	Uganda	68.40
15	Tajikistan	68.20
16	Republic of Congo	63.70
17	Sudan	63.30
18	Madagascar	59.00
19	Nepal	58.20
20	Guinea	57.50
21	Burkina Faso	56.20
22	Cameroon	54.30
23	Angola	51.70
24	Gambia	51.60
25	Bangladesh	51.00
26	Comoros	47.80
27	Benin	47.40
28	Mali	46.60
29	Tanzania	45.90
30	Honduras	45.80
31	Guatemala	44.10
32	Iran	43.70
33	Papua New Guinea	39.50
34	Nicaragua	38.30
35	Pakistan	33.70
36	Lithuania	32.60
37	Lesotho	30.00
38	Belize	29.50
39	Sri Lanka	29.20
40	Senegal	28.40
41	Egypt	26.60
42	Iraq	26.40
43	Paraguay	25.20
44	Brazil	23.10
45	Iceland	22.60
46	Cabo Verde	21.60
47	Botswana	20.90
47	Morocco	20.90
49	Laos	20.50
50	India	20.40
51	Hungary	20.20
52	Haiti	19.10
53	Armenia	19.00
54	Ecuador	18.20
55	Indonesia	17.30
55	Kenya	17.30
55	Rwanda	17.30
58	Philippines	16.60
59	Gabon	15.80
60	Colombia	15.10
61	Bolivia	14.30
62	Chile	13.80
63	Tunisia	13.60
64	El Salvador	13.30
65	Namibia	11.50
65	South Africa	11.50
67	Malaysia	11.30
68	Algeria	10.80
68	Russia	10.80
68	Seychelles	10.80
71	Mongolia	10.40
72	Ghana	9.10
73	Costa Rica	8.90
74	Mauritius	8.80
75	Venezuela	8.60
76	Mexico	8.20
77	Cyprus	6.10
78	Dominican Republic	5.70
79	Ethiopia	5.60
79	Ukraine	5.60
81	Portugal	5.20
82	Bulgaria	5.00
82	Serbia	5.00
84	Montenegro	4.70
85	Argentina	4.50
86	Peru	4.40
87	Lebanon	4.10
88	China	3.70
89	Solomon Islands	3.30
90	Albania	3.10
90	Jamaica	3.10
92	Timor-Leste	2.90
93	Georgia	2.60
94	Greece	2.30
95	Bosnia and Herzegovina	2.20
96	Samoa	1.80
97	Israel	1.70
98	Bhutan	1.60
99	Belarus	1.50
100	Switzerland	1.00
101	Moldova	0.90
102	Italy	0.70
102	Spain	0.70
102	Vanuatu	0.70
105	Japan	0.50
106	Croatia	0.40
106	Kazakhstan	0.40
106	Luxembourg	0.40
106	United Arab Emirates	0.40
110	Thailand	0.30
110	United States	0.30
112	Austria	0.20
113	Australia	0.10
113	Canada	0.10
113	France	0.10
113	Ireland	0.10
113	South Korea	0.10
113	Poland	0.10
113	Romania	0.10
113	Slovenia	0.10
121	Belgium	0.00
121	Denmark	0.00
121	Finland	0.00
121	Germany	0.00
121	Kiribati	0.00
121	Marshall Islands	0.00
121	Netherlands	0.00
121	Norway	0.00
121	Slovakia	0.00
121	Sweden	0.00
121	United Kingdom	0.00

Analysis

This metric measures the proportion of a population at risk of catastrophic expenditure when surgical care is required. Catastrophic expenditure is defined as direct out of pocket payments for surgical and anaesthesia care exceeding 10% of total income. The unit is percentage of people at risk, and a higher value indicates a greater share of the population exposed to financial hardship from surgical costs. The indicator covers only direct out-of-pocket surgical and anaesthesia payments; other healthcare costs are not included. Data are drawn from the World Bank World Development Indicators (indicator code SH.SGR.CRSK.ZS), with 131 countries covered, 94.7% of which have data from the last seven years, and 100% of data points classified as official-quality. The latest reference year is 2022, with 86.3% of countries reporting in that year.

The ten highest-ranked countries, all recording above 80%, are concentrated in sub-Saharan Africa and conflict-affected states. Cote d'Ivoire leads at 100%, followed by Burundi at 97.8%, Yemen at 93.4%, Latvia at 89.9%, and Syria at 87.5%. Guinea-Bissau (86.5%), Niger (86.3%), Democratic Republic of Congo (85%), Sierra Leone (84.3%), and Chad (82.4%) complete the top ten. These countries share limited public funding for healthcare, meaning surgical costs are borne almost entirely by individuals. Estonia (rank 11, 78.3%) and Lithuania (rank 36, 32.6%) are notable as high-income European Union members appearing alongside low-income nations in the upper portion of the ranking.

In the middle of the ranking, values range from roughly 20% to 50%. Countries such as Bangladesh (rank 25, 51%), India (rank 50, 20.4%), and Indonesia (rank 55, 17.3%) represent large populations where a significant minority faces catastrophic surgical costs. Brazil ranks 44th at 23.1%, while Chile sits at rank 62 with 13.8%. At the lower end of risk, countries such as China (rank 88, 3.7%), Georgia (rank 93, 2.6%), and Belarus (rank 99, 1.5%) show substantially reduced exposure. The United States appears at rank 110 with just 0.3%, placing it among countries with the lowest recorded risk despite its well-documented high healthcare costs, which reflects the specific definition used here rather than overall healthcare affordability.

Several limitations apply to this metric. The definition captures only out-of-pocket surgical and anaesthesia payments exceeding 10% of income and does not account for indirect costs such as travel, post-operative care, or lost income during recovery. Countries with very low surgical utilization may show artificially low risk figures if people forgo surgery rather than face the cost. Differences in income measurement and surgical cost data collection across countries can affect comparability. The 2022 reference year applies to 86.3% of countries; the remainder use earlier estimates, which may not reflect current conditions. The full range of 0% to 100% and the average year-over-year change of 36.8% suggest significant variation both across countries and over time, which should be considered when drawing comparisons.

Methodology

Data are sourced from the World Bank World Development Indicators, indicator code SH.SGR.CRSK.ZS, with a primary reference year of 2022. The metric measures the proportion of population at risk of catastrophic expenditure when surgical care is required. Catastrophic expenditure is defined as direct out of pocket payments for surgical and anaesthesia care exceeding 10% of total income. Coverage includes 131 countries, of which 94.7% have data from the last seven years and 86.3% report specifically for 2022. All 131 data points are classified as official quality. No extreme outliers were identified using a 3-standard-deviation threshold. The average year-over-year change across the dataset is 36.8%, below the 50% volatility threshold. Values range from 0% to 100%, a spread of 999% relative to the minimum. No microstates (population under 1 million) are included in the 131-country sample.

Sources

World Bank