Expat healthcare is a big worry for many Brits leaving for a new life overseas and waving goodbye to free medical cover offered by the UK’s NHS, National Health Service.
Standards are not the problem. Many countries have health services that are as good or even better than the NHS.
Table of contents
- How do overseas health services match the NHS?
- Why life expectancy is important
- Expat health services around the world
- Australia Healthcare
- Spain Healthcare
- USA Healthcare
- Canada Healthcare
- Ireland Healthcare
- New Zealand Healthcare
- South Africa Healthcare
- France Healthcare
- Germany Healthcare
- Portugal Healthcare
- Expat Healthcare FAQ’s
- Other Related Articles
- Questions or Comments
The main difference between the NHS and healthcare overseas is cost.
Expect a bill for popping to the doctor or calling an ambulance in most popular expat destinations.
You don’t have to worry about being abandoned if you cannot pay, but you must plan to pay thousands of pounds for having a baby or a major operation.
How do overseas health services match the NHS?
Two in-depth surveys look at healthcare standards in the world’s leading developed nations.
The Euro Health Consumer Index (EHCI) offers an in-depth look at health services across Europe and offers some surprising conclusions about the NHS.
The latest index, with data from 2018 published in 2019, ranks the UK NHS 16th out of 33 countries on par with Estonia and the Czech Republic.
The authors point out that since the survey started in 2005, the NHS has never enjoyed a top 10 placing.
The OECD Better Life Index is published each year and asks thousands of people worldwide about healthcare in the country where they live.
When asked about their health, 69% of Brits answered ‘good’, which is in line with the OECD average.
But the overall the UK ranks 21st out of 40 countries surveyed by the OECD.
Life expectancy at birth is 81 years, just above the OECD average and a year behind leader Canada.
Why life expectancy is important
The rule of thumb for health services is the more a government spends per head on medical care, the higher the age expectancy someone has at birth.
The OECD average is 80 years, so a child born in 2020 should live until the year 2100. In some OECD countries, this rises until 2102.
Spending is not the only factor on longevity. Lifestyle, education and living standards also have a bearing.
UK longevity, according to the OECD, is 83 years for women and 79 for men.
Expat health services around the world
Here we look in more detail at health services in the top 10 countries where British expats settle. The list is in order of popularity with Brits moving abroad.
Australia tops the list with more than 1.3 million Brits now living there, while the top 10 countries are now home to more than 4.5 million British expats.
Australia Healthcare
The OECD ranks Australia third in the list of most healthy countries with a life expectancy of 82 years, while 85% of people reckon they are in good health.
Medicare is Australia’s healthcare system that compares to the NHS. The cost of care is subsidised for expats who have become permanent residents, but everyone is encouraged to buy private health insurance.
Medicare helps with the cost of seeing a doctor, tests and scans, surgery and eye tests.
Ambulances, dental care, glasses and contact lenses and cosmetic surgery are not covered.
Expats must sign up for a Medicare card to access the service.
Spain Healthcare
Spain’s health service has about the same rating as the NHS with the OECD and EHCI.
Expats must register as resident with their local town hall to access the service.
Anyone working pays for health treatment through their social security deductions, just like in the UK.
Retired expats drawing a state pension from another EU country are treated free but may have to pay for prescriptions. How much is paid depends on income levels.
Dentists are not covered by the public health services and only offer private treatment.
The UK Foreign Office publishes a detailed guide on how to access healthcare in Spain for expats.
USA Healthcare
Healthcare in the United States is notoriously costly, and although ranked the sixth best service in the world, life expectancy at birth is one of the lowest for a developed country – at 78.8 years.
Despite the cost, 87.5% of Americans believe they are in good health.
The first stop for medical care is a GP or accident and emergency room where expats must show they have the means to pay before treatment starts.
Treatment from there depends on expat insurance cover as some hospitals and doctors only work with certain insurers.
Insurance costs depend on your state of health and pre-existing conditions, but a non-smoking 50-year-old living in Florida would pay around $265 a month (£200).
Canada Healthcare
Canada has one of the world’s best health services, with 88.7% of Canadians reporting good health against an OECD average of 69%. Life expectancy is 82 years.
The OECD particularly praised Canada for long-term care provided for the elderly when giving the country top marks for health.
Most healthcare is free in Canada for residents, including expats, with public health insurance.
Like the NHS, dental care, optician services and prescriptions are excluded.
Insurance cover and treatment costs vary between states.
Check out our guide for expats living in Canada for more insights.
Ireland Healthcare
Although ranked fifth best by the OECD with a life expectancy of 82 years, Ireland suffers from long waiting lists that leave patients queuing for treatment.
For this reason, Ireland was listed bottom out of 33 countries for accessibility by the EHCI.
Changes to the law allowing abortions have helped improve patient outcomes.
Healthcare is generally free. To receive treatment, expats must prove they have lived in the country for at least a year or that they intend to settle. Proof generally involves showing you own or rent a home in Ireland.
Ireland also offers tax relief on some private medical expenses that are not offered by the public healthcare system.
New Zealand Healthcare
The New Zealand health service is ranked second behind Canada by the OECD, life expectancy is 82 years and a huge 90% of the population say they are in good health.
Expats who are resident or hold a work visa valid for more than two years from their arrival date in New Zealand qualify for healthcare but may have to pay for some services. Doctor visits are billed between NZ$45 and NZ$55 (£22 – £27).
A ride in an ambulance costs NZ$100 (£50) if you are a resident signed up with the Accident Compensation Corporation – but up to NZ$800 (£400) if not, so it’s worth registering as soon as possible.
Health insurance starts at NZ$130 a month (£65) for a 50-year-old non-smoker in good health.
South Africa Healthcare
Healthcare in South Africa suffers a great divide. The free public health service is underfunded and overcrowded, while the private health system is among the best in the world.
In South Africa, expats get the healthcare they are willing to pay for.
Basic medical aid is cheap but won’t cover long-term treatment of serious conditions. Some expats have seen their local insurance cancelled when reporting a claim.
The UK government warns expats to take out adequate health cover before arrival in South Africa.
Life expectancy is 58 years – 22 years lower than the average of 80 and the worst in the OECD.
France Healthcare
The health service in France ranks on a par with the UK NHS, according to the OECD.
The EHCI ranks France as 11th in Europe, with the poor score mainly blamed on long waiting lists.
Expats who live and work in France can join the public healthcare system (PUMa). State healthcare comes at a cost, but some charges are reimbursed.
How expats join the French health system depends on their residence status.
Cover is generally available after expats have lived in France for three months and intend stay in the country for at least six months in a year.
Germany Healthcare
Germany also ranks alongside Britain and France in both the OECD list and the EHCI survey. Life expectancy is 81 years, just over the OECD average of 80 years.
The healthcare system is accessed by taking out medical insurance, which is compulsory for everyone. The state scheme is called Krankenkasse (GVK), while the private scheme is under a Krankenversicherung (PVK) policy.
Expats must show proof of cover when applying for a visa or residency permit.
The system covers the retired as well as workers.
Health insurance offers in-patient treatment at hospitals as well as local doctor services.
Portugal Healthcare
The health service in Portugal is another that ranks alongside the UK NHS, France and Germany.
Standards of care are rated good, while life expectancy is 81 years, but only 48% of the population say they feel in good health.
Besides the state system, Portugal has a well-established network of private hospitals.
Expats in Portugal do not automatically qualify for the public health system unless they have registered for a residency permit.
UK state pensioners should register with a Form S1
Make sure to read our complete guide to healthcare in Portugal for expats.
Expat Healthcare FAQ’s
Healthcare rules are country-specific, so expats with queries about the state or private system in a particular place should take local advice.
In some countries, healthcare can vary between regions and some need evidence of adequate medical insurance from expats before they enter the country.
Here are the answers to some of the general most asked questions about healthcare from expats.
Expats outside the European Economic Area (EEA) should not notice any difference to their healthcare once Britain leaves the European Union on December 31, 2020.
Inside Europe, expat healthcare should not be disrupted by Brexit as Brits settled abroad already have to abide by local rules that apply to their medical treatment.
Tourists and frequent travellers are likely to lose their cover under the European Health Insurance Card (EHIC).
Canada and France often win plaudits as offering the world’s best health services, but it depends on the criteria benchmarking performance.
For instance, the tiny EU state of Montenegro has adopted a system of public healthcare that has virtually done away with waiting lists by changing the way the delivery of treatment is managed.
Yes, but if an expat is resident elsewhere the NHS is not free of charge. If the expat is visiting from Europe, they will need their new home country’s version of the EHIC (If resident in the EEA) and travel insurance just as British tourists and business travellers need when they visit overseas.
The US healthcare system is the most expensive in the world and patients must show proof they can pay their bills before treatment starts. The US spends more on the same drugs and treatments than any other country.
Drugs and consulting a doctor are five times more expensive in the US than any other country – $1,600 a head compared to $310.
The World Health Organisation ranks the health service in the African nation of Sierra Leone as the worst in the world, but many other African countries are not much better.
The WHO also publishes healthcare comparison statistics by country each year which score each country based on a range of factors, from standards of treatment to investment in health infrastructure by governments.
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