Moving abroad could be one of the biggest decisions you’ll ever make. Even if you’re already an expat and are looking for your next location, you’ll have a checklist of things to look into in order to make an informed decision. Education, housing, cost of living, jobs, social life and healthcare all need to be carefully researched.
In another of our guides, we’ve looked into the best and worst countries to move to as an expat, taking into account quality of life, ease of settling in, working abroad, personal finance and expat essentials as set out by the Internations Expat Insider 2024 survey. In this guide, we’ll use the same survey but look instead at how expats feel about the healthcare provision where they live.
We chose to use the Internations Expat Insider survey because it reflects the empirical opinions of expats in over 174 countries. With healthcare being a major concern for anyone moving abroad, who better to ask than expats themselves?
There are many other surveys out there, but they rely on statistical data and don’t paint a picture of what it’s like to deal with a particular country’s healthcare system on a day-to-day basis. Sharing valuable insights into their lived experience abroad is an expat super-power, and it’ll help bring nuance and context to your decision-making process.
The Internations Expat Insider survey gathers data from more than 12,500 expats worldwide, who represent 175 nationalities, live in 174 countries or territories and who have all shared their opinions on everyday life abroad. They rated up to 56 aspects of expat life, such as the cost of living, the availability of housing, career prospects, their social life and the quality of medical care.
Let’s dive right in, then. Here are the five best healthcare systems in the world, ranked by the expats who use them:
South Korea may be on the list of worst countries to move to as an expat, but expats can’t fault the healthcare. In fact, according to the Internations Expat Insider 2024 survey, expats say South Korea has the best health systems in the world.
Affordable. Advanced technology. Highly trained doctors.
Low doctor-to-patient-ratio.
South Korea’s healthcare system is called the National Health Insurance Service (NHIS). It ensures universal medical care to all citizens as well as expats who have lived in the country for longer than six months. You’ll generally pay around five percent of your monthly salary to access the NHIS and your employer will also contribute. If you’re moving to South Korea as a digital nomad or are self-employed, you’ll have to cover 100% of your NHIS payments.
The NHIS will cover most of your medical expenses, but not all. Like in Taiwan, a system of co-payments exists.
Strike action due to long working hours and low pay is putting pressure on South Korea’s public healthcare system. Because doctors are in such high demand, you could be dealing with longer waiting times should you need to go to hospital.
According to Statista, around 78.6% of people in Taiwan have private health insurance alongside universal healthcare in order to cover the co-payments. While expats say international health insurance is necessary in South Korea to cover co-payments, they did not report shorter waiting times.
Qatar slides in at number two, with expats agreeing the country has some of the best healthcare in the world. With international medical staff, state-of-the-art medical facilities and numerous 24-hour medical clinics, expats are confident their medical needs are well taken care of.
International medical professionals. World class medical facilities. Short waiting times.
High levels of bureaucracy in the public sector.
Qatar has seen massive investment in its health sector over the past decade. Hospitals are modern and kitted out with the very latest cutting-edge technology.
Health insurance in Qatar is compulsory for all residents, local and expat alike. With public health insurance you’ll be able to access the public health system which offers free or subsidised healthcare to all Qatari residents, including expats. Public healthcare services are run by the Primary Healthcare Centre and the Hamad Medical Corporation. There’s also a growing (and preferred) private healthcare sector which is used by expats and Qataris.
If you’re thinking of moving to Qatar, you’ll be required to apply and pay for a Health Card. This is the minimum insurance needed and will give you access to basic healthcare in Qatar’s public health system. It’s renewable every year. There may, however, be extra costs if you seek medical assistance. For this reason, most expats opt to top-up their public insurance with international health insurance so that all of their medical bills are covered.
Expats in Qatar express frustration at the level of bureaucracy surrounding public healthcare. It’s often much quicker and far simpler to go directly to private clinics or hospitals, bypassing the public system altogether. Expats also say they have easier access to medical specialists at private facilities.
Along with securing the Health Card, international health insurance is strongly recommended for expats living in Qatar; in fact, many expats negotiate health and medical cover from their employers.
Spain is at the top of most expat surveys these days. The country came third for healthcare in the Internations Expat Insider survey and ranked first overall as the best country to move to for expats. With an excellent work-life balance, the welcoming Spanish culture and excellent healthcare, what’s not to love?
Highly trained medical practitioners. Universal public healthcare. High standards of care.
Long wait times. Some extra costs.
At 83.1 years, Spain’s life expectancy is well above the European average. Perhaps healthy food, long sunny days and friendly locals help people live longer. What definitely adds longevity is the excellent healthcare system.
Spain spends 10.7% of its GDP on healthcare, which is the seventh highest among EU member states. The result is a universal public healthcare system called the Sistema Nacional de Salud which actually works for its citizens and residents. The good news is that as an expat thinking of moving to Spain, you too will have access to free or low-cost public healthcare, provided you pay the monthly social security contributions. Doctor’s visits, hospital stays and most prescription medication is covered, but there may be small additional costs for some medications or if you need to see a specialist.
Hospitals and clinics are of a modern standard. Doctors and medical practitioners are highly skilled and undergo rigorous training.
It’s hard to find fault with Spanish healthcare. According to expats, wait times could be a little shorter. The public healthcare system also doesn’t cover everything. There may be extra costs for dentistry, seeing a specialist and for doctor visits which relate to some areas of reproductive health.
For this reason, many expats and locals opt to visit private clinics and hospitals, and therefore have additional insurance to use healthcare in Spain alongside their public cover from the government.
Japan ranks fourth, and its appearance this high in the rankings shouldn’t be a surprise, given that it has some of the longest life expectancies of any country in the world. Not only is Japanese healthcare excellent, but it’s also insurance-based and heavily regulated to ensure that it’s cost-effective for all.
Cost-effective, insurance-based system; easy access to care
Overuse of emergency departments; demands of an ageing population
Japan spends more than 10% of its Gross Domestic Product (GDP) on healthcare, which is substantially higher than the global average of 8.8% , and it shows. Japan has a strong network of hospitals and smaller ‘medical clinics’, and people can generally access care quite quickly. Patients attending single-doctor clinics can generally get appointments on the same day.
Everyone is required to pay into an insurance system to access Japanese healthcare without having to cover all the medical fees themselves. This is paid for personally, or through the health insurance scheme of their employer. Medical fees are tightly regulated by the government, and the amount of contribution that insured patients have to make varies according to their age and income. The maximum is normally 30%, although those on low incomes may not have to make any contribution at all.
Fast access to high-quality care is so prevalent that many patients tend to head straight to emergency departments, even when their illnesses or injuries are very mild. Indeed, this has led to pressure on healthcare services in major cities such as Tokyo, where large numbers of people live.
Another factor that may hit care availability in the future is the changing population demographics of Japan. The country has one of the lowest birth rates in the world and its population fell by 800,000 in 2022 alone. This in turn means the population is also ageing – nearly 30% are 65 or older, and more than 10% are 80 or older. As older people tend to need more care, this will put further demand on healthcare provision.
The fifth best country for healthcare according to expats is Luxembourg. Everyone from citizens to expatriates enjoy access to public healthcare, which is heavily subsidised but not free. Public healthcare is paid for by social security contributions and patients receive medical care through a system of reimbursement.
Free choice of healthcare provider. Cost limits. Excellent doctor-to-patient ratio.
Some extra costs.
Public healthcare in Luxembourg operates on a system of reimbursement. Patients generally pay for their treatment up front, and they’re reimbursed between 80-100%. The country’s social health insurance (SHI) scheme is compulsory for all citizens and residents and as an expat, you’ll need it too. The National Health Insurance, Caisse Nationale de Sante (CNS), is responsible for reimbursements and covers general health care, sick leave and long-term care insurance. As a patient, you’ll submit your medical receipts directly to the CNS.
You’ll never wait long for an appointment in Luxembourg. There are three doctors for every 1000 people in Luxembourg, placing the country 13th in the world for doctor-patient ratio. There are also 12.2 nurses and midwives per 1000 people, which is also highly favourable. All hospitals in Luxembourg are run by the CNS, making it one of the few countries that does not have private hospitals.
That being said, many people in Luxembourg, including expats, choose to have private medical insurance in order to cover the shortfall in reimbursements.
Luxembourg’s population is growing – over 81% since 1980 and is expected to grow by another 35% by 2050. The population is also living longer. According to Statista, 18.4% of Luxembourg’s population will be aged over 65 in 2030, and 26% over 65 by 2050. The doctor-to-patient ratio looks good now, but looking to the future, Luxembourg is facing an acute doctor shortage. According to Luxembourg’s National Health Plan, the country needs to retain and recruit 1,300 doctors in the next five years. With 65% of doctors expected to retire before 2034, this is a very tall order. Luxembourg also needs to recruit 3800 nurses by 2030.
The main problem lies in the fact that junior doctors can only study medicine in Luxembourg up to a certain level. They then have to study abroad to complete their further qualifications. Once they’ve left, many do not return.
That rounds out the top five countries with the best healthcare in the world, according to the expats who live there. These countries are getting it right when it comes to public healthcare, with modern medical facilities, highly trained practitioners and a high level of care. They also all operate a form of co-payment in which some medical costs fall to the patient. In all, except Luxembourg, private healthcare runs smoothly alongside public provision, and many residents choose to have private health insurance to bridge the gap between the two.
On to the five countries with the worst healthcare in the world, according to the expats who live there. As you read this list, keep in mind that healthcare is only one piece of a larger puzzle of life abroad, and that expats can enjoy living in a country in spite of its healthcare shortcomings. Also, that this list is a compilation of popular expat locations and that there are countries in the world with much worse healthcare provision.
Coming in last place on the Internations Expat Insider survey for healthcare is Ireland. And It's not just expats who feel let down by the system. So, what’s gone wrong with healthcare in Ireland?
The government is working towards providing universal healthcare by 2030.
No universal public healthcare. Scarcity of doctors.
Ireland spends around the same amount on healthcare as Denmark or Austria but does not perform nearly as well.
Part of Ireland’s problem is it’s the only western European country without universal coverage for primary care. The public health system. is administered by the Health Service Executive (HSE), takes a two-tier approach with around 30% of the population eligible for free public healthcare through the Medical Card System. Eligibility is means- tested through assessing income, age, health status and residency.
Around 70% of the population do not qualify for free healthcare and must therefore pay for their medical care. You’ll pay around €100 (approx. £84.25, $107) to visit the emergency room, and €75 (approx. £61.18, $80.27) to attend an injury unit for burns, sprains, broken bones etc. Single room occupancy in a private hospital could cost €1000 (approx. £840, $1070) per night.
The National Library of Medicine states that Ireland is suffering from a near-critical shortage of doctors, with many choosing private practice over the public system, or leaving Ireland altogether to work abroad.
The Irish government is working towards providing universal public healthcare based on patients’ needs rather than their finances. The goal is to implement a new healthcare plan called Sláintecare by 2030. A crucial element of this is expanding the capacity of hospitals by recruiting medical staff from the private system and increasing the number of hospital beds available by taking them from the private sector.
The US is one of the top ten richest countries in the world, yet expats say its healthcare system is one of the worst.
Healthcare has always been a contentious issue in the US and continues to be so today. There is no universal public healthcare coverage and the high costs of healthcare in general means that some form of private medical insurance is a must for both citizens and expats alike.
Excellent doctors. Cutting edge medical technology.
No public universal healthcare. Healthcare costs are very high.
Despite spending $4.5 trillion on healthcare in 2022, the US scores poorly on many key health measures such as care accessibility and affordability.
There is no form of universal cover for citizens or expats, and the high cost of medical care means many people risk bankruptcy if they develop a serious illness. Prices vary widely, and it's nearly impossible to compare the quality or cost of your healthcare options. Patients are often hit with enormous bills after even routine medical treatment.
Private medical insurance is more often than not tied to employment and is part of an employee’s benefit package. If you’re moving to the US as a digital nomad, or are self-employed, you’ll need to pay for your own private health insurance, which can be costly.
This discontent is not felt exclusively amongst expats. According to the 2023 Harris Poll, 70% of Americans feel let down by their health system.
The table below shows what respondents to the Harris Poll feel are the biggest barriers to healthcare in the US.
The Affordable Care Act, adopted in 2010, shows that the US understands the need to extend affordable healthcare to its citizens. Improving healthcare coverage is a central aim, and this is being done through subsidies for the uninsured to afford private insurance.
The US government is also expanding eligibility for Medicaid (in some states) and greater protection for insured persons.
Kuwait ranks last in the Internations Expat Insider survey and is in the bottom five for healthcare and places to move to as an expat.
Kuwait has some of the best medical facilities in the gulf region and because so many of its doctors are expats themselves, there’s rarely a language barrier for patients to overcome. So why don’t expats rate its healthcare system highly?
World-class healthcare facilities. International medical staff.
Limited access to public healthcare. Private healthcare is expensive. A limited number of ambulances.
Kuwait has a free public healthcare system for Kuwaiti citizens, but as an expat you’ll need to pay to make use of it. In recent years, the public healthcare system in Kuwait has shown signs of becoming overburdened. With two thirds of Kuwait’s population being expats, Kuwaiti citizens felt pushed out of their own system. In response, the government actively discourages foreign nationals from accessing the public healthcare system.
This friction has led to an increase in demand for private healthcare, which in turn has caused the cost of private healthcare to rise. Comprehensive international health insurance can remove expats from the public system altogether and ensures they have unhindered access to the excellent private medical facilities the country has to offer.
Expats also say there are a limited number of ambulances in Kuwait, and if you need to go to hospital, you’ll have to make your own way there.
Expats can’t fault the standard of medical care in Kuwait. Hospitals are of a world-class standard; doctors and medical practitioners are often internationally educated and speak a multitude of languages to cater for Kuwait’s diverse expat population.
Within the private sector, there are no wait times and patients can expect to see a range of well qualified, experienced specialists.
Hungary is a popular destination for medical tourism , but that’s principally because care is so cheap. Hungary has one of the lowest life expectancy rates in the European Union, due to an overstretched healthcare system increasingly lacking in skills and expertise.
Increased investment in healthcare; universal insurance system
Doctors leaving the country due to low pay; extra cash payments
Most of the problems with healthcare in Hungary are down to money. Health professionals in Hungary don’t earn much more than the average wage, which is leading to a serious ‘brain drain’ as Hungarian doctors and clinicians move to other countries where they can earn much more. Some 8,500 health professionals have left Hungary in the last ten years, leading to a shortage so severe that in 2022, Hungarian hospitals were closed for a total of 15,000 days due to staff shortages.
Due to the low pay, Hungary is also a country where doctors have historically asked patients for extra under-the-table payments in cash in order to access better levels of care and treatment. Having said this, the Hungarian government has attempted to crack down on this practice in recent years, and address doctor pay.
Although the actual care itself requires improvement, the cost of the care that is provided is relatively small to Hungarian citizens. Public healthcare contributions cost citizens 8,400 forints per month (approximately £20 or $25), which gives them universal access to care when they need it.
Hungary has also invested heavily into ambulance and air ambulance services in recent years, so that as many people as possible can get urgent care, whether in urban or rural areas. With over 250 ambulance stations nationwide, the vast majority of the population can now be attended to by health professionals within 15 minutes.
Canada has long been a welcoming country to expats from all over the world, so its appearance in the bottom five of the healthcare rankings may come as a surprise. But despite considerable investment into its system by the authorities, its infrastructure is struggling to cope in a number of areas.
Strong Medicare programme. Extensive government investment.
Overcrowded and overstretched hospitals. Expensive prescriptions.
Canada has a major problem with access to hospitals and urgent care, which has been mounting for a long time. The number of hospital beds available per head of population has dropped by 63% since 1976, and this has led to serious overcrowding at many hospitals. Waiting times for emergency care are now so long that in 2023 alone, 1.3 million Canadians gave up and returned home without being seen by a healthcare professional. Similar difficulties have also been experienced with the Canadian ambulance services.
Additionally, the amounts that Canadians have to pay for their prescriptions are the third highest among developed nations globally.
Investment into healthcare in Canada is good, both by the authorities and the public. Healthcare spending runs at 12.1% of GDP, while many Canadians invest in supplementary health insurance to cover areas that aren’t covered by the universal Medicare program, such as dentistry, physical therapy, optical care and prescriptions. Generally speaking, the provisions of Medicare extend to around 70% of Canadians’ healthcare needs, meaning that they are generally well-covered for most of their essential needs, irrespective of income.
So, there you have it – the best and worst healthcare systems in the world ranked by the expats who use them.
There are a few common trends that we can summarise. The top five countries (except Luxembourg) all offer universal public healthcare alongside a system of co-payment. In the countries with the worst healthcare systems, public healthcare is either not as accessible to expats or falls below modern standards.
In both instances, international health insurance can bridge any out-of-pocket payments you may incur as an expat and guarantees a standard of medical care that’ll put your mind at ease and allow you to focus on settling into your new life abroad with confidence. At AXA - Global Healthcare, we can provide all the cover you need, wherever you’re planning to move to. To find out more, visit International Health Insurance: AXA - Global Healthcare.
Local insights have been provided by Oban International’s LIME (Local In-Market Expert) network: https://obaninternational.com/lime-network/
