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

Ranking 2022

Values shown in %.

Analysis

This metric measures the proportion of a population at risk of impoverishing expenditure when surgical care is required. Impoverishing expenditure is defined as direct out-of-pocket payments for surgical and anaesthesia care which drive people below a poverty threshold (using a threshold of $2.15 PPP/day). The unit is percentage of population. Higher values indicate that more people face this financial risk, making a higher rank in this dataset a worse outcome in practical terms. Data covers 131 countries sourced from the World Bank World Development Indicators (indicator code SH.SGR.IRSK.ZS), with 94.7% of entries from the last seven years and 100% classified as official data. The data year is 2022, with 86.3% of countries reporting in that year specifically.

The highest-risk countries are concentrated in sub-Saharan Africa and South Asia. Burundi and Cote d'Ivoire both record 100% at ranks 1 and 1. Congo, Dem. Rep. follows at rank 3 with 98%, Madagascar at rank 4 with 96.1%, and Niger at rank 5 with 96%. Papua New Guinea (rank 6, 95.8%), Sierra Leone (rank 7, 93.4%), Tanzania (rank 8, 91.5%), Uganda (rank 9, 88.5%), and Timor-Leste (rank 10, 87.2%) complete the top ten. Nepal ranks 11th at 86.6% and Yemen ranks 12th at 86.5%, indicating the risk extends into South Asia and conflict-affected regions.

The middle of the ranking shows substantial variation. Bangladesh sits at rank 25 with 67.3%, while India reaches rank 39 at 40.2% and Pakistan rank 40 at 39.9%. In Latin America, Nicaragua ranks 33rd at 50% and Bolivia 38th at 43.5%, while Chile ranks 67th at 14.3% and Costa Rica 72nd at 10.4%. A notable anomaly is the United States at rank 107 with 0.2%, placing it alongside France, Italy, and Spain rather than near the 0% group of comparably wealthy nations such as Canada (rank 116, 0%) and Germany (rank 116, 0%). Latvia ranks 69th at 11.8%, higher than several lower-income countries, while Lebanon ranks 96th at 1.8% despite well-documented economic instability visible elsewhere in the data.

Several limitations apply to this metric. The poverty threshold of $2.15 PPP per day is a single fixed benchmark; populations just above this line who still face catastrophic costs are not counted. The metric captures risk exposure, not actual incidence of impoverishment, meaning countries with low surgical utilisation rates may show lower risk simply because fewer people seek care. Cross-country comparisons may be affected by differences in how out-of-pocket costs are measured and reported. The 7-country gap in data recency (7 of 131 countries have data older than seven years) introduces some inconsistency. Countries without sufficient household survey data are excluded entirely, which may skew the sample toward countries with stronger data infrastructure.

Methodology

Data is drawn from the World Bank World Development Indicators, indicator code SH.SGR.IRSK.ZS, with a reference year of 2022. The metric measures the proportion of population at risk of impoverishing expenditure when surgical care is required; impoverishing expenditure is defined as direct out-of-pocket payments for surgical and anaesthesia care which drive people below a poverty threshold (using a threshold of $2.15 PPP/day). The ranking covers 131 countries, exceeding the 80-country coverage threshold. Of these, 124 (94.7%) have data from within the last seven years, and 113 (86.3%) report specifically for 2022. All 131 data points (100%) are classified as official data. No extreme outliers were identified using a 3-standard-deviation threshold. Average year-over-year change across the dataset is 17.3%, well below the 50% volatility threshold. Values range from 0.00% to 100.00%, a spread of 999%. No microstates (populations under 1 million) are included in the dataset.

Sources

• World Bank