Better data on unmet healthcare need can strengthen global monitoring of universal health coverage

During the covid-19 pandemic, nearly one fifth of households in 39 low and middle income countries did not access healthcare when needed because of fear of contracting covid-19, movement restrictions, or financial constraints.1 Even in high income settings, estimates suggest almost half of young Europeans aged 18-29 had unmet needs for mental healthcare during the pandemic.2 We define unmet need as the presence of healthcare needs for which people do not or cannot receive quality healthcare.3 This may lead to poor health outcomes, high spending, and productivity loss to individuals and society. Despite its importance for ensuring people’s right to health, current efforts to measure how well a health system is delivering services do not include unmet need. In 2023, the 76th World Health Assembly adopted a resolution requesting the WHO’s director general to review the importance and feasibility of using unmet need for healthcare services as an additional indicator to monitor universal health coverage (UHC) nationally and globally.4 UHC is achieved when all people have access to the full range of quality health services they need without financial hardship5 and is one of 12 targets of the sustainable development goal on health and wellbeing (SDG 3).6 Two indicators are used to track progress toward UHC (health service coverage and catastrophic health spending), but neither measures unmet need as they only include people who have actually received care. A measure is thus needed that captures the experience of people who needed healthcare but could not receive it because of limited availability, affordability, or quality.