Earlier this month, the Daily Express revealed the results of a survey, which suggests that Italy provides the best healthcare for expats. Next is Germany, which also has a national healthcare system, in addition to wide range of private providers. Germany has the highest number of hospital beds on the list. In third and fourth place come the Netherlands and Spain. According to a separate study from the World Population Review, the latter is the healthiest country in the world. The rest of the list is comprised of the UAE, Switzerland, the UK (at number 7), Canada, France and the USA. We’ll take a look at some of these healthcare systems in more detail below.
Italian healthcare system
The Italian healthcare system, the Servizio Sanitario Nazionale (SSN), is funded through taxation and national insurance. Employers pay contributions directly into the system. Currently, the plan covers all Italian residents, including expats. Contributions are mandatory, and there is no opt-out clause, although you can take out private cover as a top-up or rely solely on your private insurance. You can find more information on Italian healthcare here.
German healthcare system
The German state health insurance system, gesetzliche Krankenversicherung or Gesetzliche Krankenkasse (GKV) is run by the German social security system, which governs around 110 insurers. The system is supported by statutory health insurance funds, which operate on two core principles: the solidarity principle (i.e. anyone needing medical treatment will receive it) and the principle of benefits in kind (you will not have to make upfront payments for medical care). Currently, approximately 90% of the German population is covered under state medical insurance, and you’ll be eligible as an expat if you’re registered and if you’re paying into the system. You can find more information on German healthcare here.
Dutch healthcare system
The Netherlands is in line with most EU countries with regard to medical insurance. The basic coverage (basisverzekering) system has emerged out of a group of private health insurers and has been revised within the last 15 years. The government is responsible for it, but does not run it. Funding comes from taxes and compulsory health insurance fees. It is a two-tier system, consisting of compulsory basic insurance (basisverzekering) and optional additional insurance (aanvullende verzekering). The Netherlands has consistently ranked highly in the Euro Health Consumer Index, taking the top spot for several years running, but the levels of bureaucracy can prove tricky to navigate. You can find more information on Dutch healthcare here.
Spanish healthcare system
In fourth place, Spain also has a two-tier health insurance scheme, consisting of both public healthcare (asistencia sanitaria pública), run by the National Health System (seguridad social/SNS), and private cover (privado). Around 90% of the Spanish population is registered with the national scheme, and as an expat resident in Spain, you will also be able to access this, as long as you are registered and are making contributions into the system. Spanish citizens and permanent residents pay into the scheme through payroll deductions, if they are in employment. You can find more information on Spanish healthcare here.
Emirati healthcare system
Healthcare throughout the Emirates is of a high standard, whether it is government-funded or private. If you are not covered by a scheme associated with your employer (or if they have provided cover and you want to top it up), you will need to take out private health insurance. However, the healthcare system is currently being revised. Dhaman, the name of the new healthcare scheme, has been given the task of providing mandatory health insurance to some two million expats in the country from 2023 onwards. You can find more information on Emirati healthcare here.
Swiss healthcare system
Rather than funding via social service contributions, the Swiss healthcare system is organised by cantons. There is no central system, and your canton of residence will determine how you claim back your healthcare costs. In some areas, for example, your insurer will pay your healthcare provider directly and send you a bill for some of the cost, whereas in some cantons, you will have to pay your healthcare costs upfront. You can find more information on Swiss healthcare here.
Canadian healthcare system
In Canada, healthcare is organised on a regional basis. The Canadian state system, commonly referred to as Medicare, is split across the different provinces and territories. Your employer will probably sign you up for a particular group policy, which is compulsory, so your choice of health insurance is limited. You can find more information on Canadian healthcare here.
French healthcare system
The French system, like many other European systems, is paid for out of social security contributions, and it is supplemented by private health insurance. The system has recently been revised. In 2016, the Protection Universelle Maladie (PUMa) replaced the old system. You can find more information on French healthcare here.
US healthcare system
Finally, the USA does not have a comprehensive national health insurance system, thus its citizens must take out private health insurance. A few categories of people are covered by Medicare and Medicaid – the closest to a national system that the USA possesses. Expats are usually not eligible for registering with this system, but can sign up with private providers. Healthcare is of a very high standard. You can find more information on American healthcare here.
All of these countries are popular destinations for expats, and it is reassuring to know that if you plan to relocate to any of them, including the UK, you will find high quality healthcare in both the public and the private sectors.