From Better Health Access to Rising Medical Debt: What Is Going Wrong in the Western Pacific?

A WHO report reveals that despite major improvements in health care access across the Western Pacific, rising medical costs, workforce shortages and inequalities continue to threaten millions of households. The report urges governments to strengthen primary health care, expand financial protection and invest in resilient health systems to achieve universal health coverage by 2030.

The World Health Organization (WHO) Regional Office for the Western Pacific, in collaboration with Peking University's China Center for Health Development Studies, has highlighted growing inequalities in access to affordable health care across the Western Pacific. Its 2026 report, Universal Health Coverage Country Diagnostics: Regional Overview and Country Diagnostics in the Western Pacific Region, examines health systems across 26 countries and areas. The findings reveal a major challenge: while medical services have expanded significantly, millions of people continue to struggle with rising treatment costs, shortages of health professionals and unequal access to essential care. The report warns that achieving universal health coverage by 2030 will require stronger government investment, better financial protection and more accessible health services.

Health Care Expands, but Rising Medical Bills Threaten Families

The Western Pacific has made substantial progress in improving health services over the past two decades. The region's Universal Health Coverage Service Coverage Index increased from 49 in 2000 to 79 in 2021, reflecting wider access to essential medical services. However, progress has slowed considerably since 2015, when the index stood at 75.

More concerning is the growing financial burden on households. The proportion of people experiencing catastrophic health expenditure doubled from 9.9% in 2000 to 19.8% in 2019. This means nearly one in five people faced medical expenses exceeding 10% of their household income or consumption.

These findings reveal a serious weakness in health systems. Although more people can reach hospitals and clinics, treatment remains financially difficult for many families. High medicine prices, specialist consultations and hospital charges can force households to reduce spending on food, education and other necessities.

The report emphasizes that expanding health insurance alone cannot guarantee affordable treatment. Governments must ensure that insurance schemes cover essential services while reducing direct payments by patients.

Unequal Health Systems Leave Millions Facing Different Challenges

Health care conditions vary considerably across the Western Pacific. Countries such as Japan and Australia have developed extensive health insurance arrangements and advanced medical infrastructure, while several Pacific island nations face limited budgets, workforce shortages and geographical barriers.

China's service coverage index increased from 47 in 2000 to 81 in 2021, demonstrating significant improvements in health access. However, medical expenses remain a concern, particularly for people requiring long-term treatment.

Vietnam has expanded social health insurance to approximately 93% of its population. Nevertheless, out-of-pocket payments accounted for 45.1% of health expenditure in 2019, while 8.5% of people experienced catastrophic health spending in 2020.

Mongolia also faces difficulties protecting insured patients from substantial medical bills, particularly for medicines and specialized treatment.

The Philippines has introduced reforms through its Universal Health Care Act and Sin Tax Law, which directs revenue from tobacco and alcohol taxation towards health priorities. However, gaps in financing, medicine availability and medical staffing continue to affect disadvantaged communities.

These differences highlight the importance of policies tailored to each country's economic conditions, population needs and health infrastructure.

Shortages of Doctors and Weak Primary Care Increase Pressure on Hospitals

The report identifies stronger primary health care as essential for improving medical access and controlling treatment costs. Community health centres can provide vaccinations, maternal care, disease screening and treatment for chronic conditions, reducing unnecessary pressure on expensive hospitals.

Vietnam has established health stations in 98.7% of communes, yet many patients continue to bypass local facilities in favour of larger hospitals. Similar challenges exist in the Republic of Korea, where weaknesses in referral arrangements contribute to heavy hospital use.

Health workforce shortages create additional difficulties. Australia and New Zealand struggle to attract professionals to remote communities, while Samoa and Vanuatu face limited training opportunities and the migration of medical workers.

Papua New Guinea experiences particularly serious barriers because of inadequate infrastructure, insufficient financing and shortages of essential medical supplies.

Digital health technologies could help address some of these problems. Electronic medical records, remote consultations and better information systems can improve coordination and expand services to isolated communities. However, unreliable internet connectivity and limited technical capacity remain major obstacles.

Climate Threats and Ageing Populations Demand Stronger Health Policies

Beyond immediate medical challenges, the Western Pacific faces growing pressure from climate change, ageing populations and rising demand for treatment of chronic diseases.

Pacific island countries are particularly vulnerable to extreme weather. Cyclones, flooding and rising sea levels threaten medical facilities, disrupt medicine supplies and make health services harder to deliver. Fiji, Tuvalu and Kiribati illustrate the importance of building health systems that can withstand environmental disasters.

Population ageing is creating additional financial and service pressures in countries including Japan, China and the Republic of Korea. Governments must prepare for greater demand for long-term care, chronic disease management and community-based support.

The report calls for stronger public financing, affordable medicines, improved workforce distribution and more reliable primary health care. International development partners can contribute through technical assistance, sustainable investment and institutional capacity-building.

For policymakers, the central message is clear: expanding health services must go hand in hand with protecting households from medical expenses. Without coordinated reforms, the Western Pacific risks reaching 2030 with better health infrastructure but continuing inequalities in who can afford quality treatment.