Financial protection is a cornerstone of Universal Health Coverage, yet millions of households worldwide continue to face catastrophic or impoverishing health expenditures. Understanding who is most vulnerable is essential for designing equitable policies and interventions. However, evidence on the socioeconomic and health system factors that drive financial hardship has been scattered and often inconsistent.
A new global systematic review published in BMJ Global Health (2008–2023) addresses this gap by synthesising findings from 85 studies across all WHO regions. The review identifies clear patterns: rural households, those with older members, without private insurance, or with recent health service use are at greater risk of financial distress. Yet, current financial protection indicators often underrepresent hardship among the poorest populations. For healthcare professionals, these insights highlight the urgent need for more refined tools to assess vulnerability and guide policies that protect patients from financial barriers to care.