14 Countries with Better Healthcare Than the United States - The Expat Test (2024)

Despite Americans who claim it’s the greatest country on earth, the United States is not exceptional when it comes to healthcare. It is, however, the most expensive.

According to a 2023 report from the Commonwealth Fund, U.S. healthcare ranks highest worldwide in terms of costs, spending nearly 18 percent of GDP on health outcomes. Despite that, the country topped the list for infant mortality among high-income countries, recording 5.4 deaths per 1000 live births in 2020—more than triple that of Norway. The United States also recorded maternal mortality rates 3x those of other high-income countries in 2020, logging 23.8 maternal deaths per 100,000 live births.

Perhaps that’s because, unlike other developed nations like Spain, the U.S. doesn’t view public healthcare as a human right. It allows a significant portion of its population to go uninsured, according to the Commonwealth Fund, or even file bankruptcy after receiving life-saving medical care. Most other Americans see their health insurance tied to an employer. This can limit job mobility if they get sick or see quality healthcare eliminated by said employer.

Does it have to be this way? Is the United States health system really the best that its citizens can hope for? Nations like Costa Rica offer universal healthcare and high standards of care for their citizens—would any of them welcome US expats? Could these countries offer better medical treatment, greater life expectancy, and lower costs for medical insurance?

The short answer is “yes.” In some cases, countries have much better healthcare than the United States, and in others, countries have marginally worse outcomes but much more affordable, accessible care. Read on to learn about 14 countries with better healthcare than the US that you could immigrate to:

1) Mexico

Advantages: transparent pricing, universal healthcare, affordable private insurance

Mexico’s healthcare system consists of both public and private institutions which are well equipped to address various needs from basic emergencies to complex surgery. Furthermore, their public health programs provide citizens with universal access to a wide range of services including vaccinations for children, diabetes management for adults, and prenatal checkups for expectant mothers, among many others.

Mexico is known to have transparent pricing when it comes to healthcare, which makes its out-of-pocket costs relatively easy to predict. In general, cash (or credit card) payment must be made for care received. As with most healthcare systems, medications can be purchased at a pharmacy without a prescription. Prices are typically lower than what you might find in other countries due to the transparent pricing system in Mexico, making it more financially feasible for those who are able to purchase their medicine there.

2) Germany

Advantages: universal healthcare, pre-existing conditions covered, nominal fees, EHIC qualified

Germany’s public healthcare system gets its funding from general wage contributions and supplemental contributions, shared among employers and workers. Nongovernmental insurers known as sickness funds manage insurance administration duties. These sickness funds provide a range of deductibles, with copays applied to inpatient services and drugs. While it maintains broad regulatory power, the federal government doesn’t directly control healthcare delivery.

Health insurance is compulsory for all residents here, regardless of employment. Germany’s big draw in its insurance scheme lies in out-of-pocket spending caps, preventing residents from getting crushed by medical debt. Expats can participate in the statutory plan if they’re formally employed by a company in Germany or pay into the system directly. Otherwise, you’ll need to have comprehensive health insurance in place before arriving here.

Another benefit of Germany’s universal health: you cannot be turned down for pre-existing conditions within the public system. Being a member of the European Union gives additional flexibility to its residents, too: the European Health Insurance Card (EHIC) grants access to medically necessary, state-provided healthcare throughout the EU under the same conditions and cost as people insured in that country. You’ll see this “EHIC qualified” phrase show up often in the “Advantages” sections of these countries.

3) Finland

Advantages: universal healthcare, EHIC qualified, low out-of-pocket max

Finland’s healthcare system is based on public healthcare services to which everyone residing in the country is entitled. This national health insurance plan is part of the social security system and implemented by Kela, the Social Insurance Institution of Finland. In addition, numerous private healthcare services operate in the country.

Public healthcare is extended to all residents of a Finnish municipality and those who carry a certificate of entitlement for medical care. Those who aren’t covered by these options may choose to pay out of pocket for their medical care in both public and private systems. Emergency care is provided free of charge to all, regardless of residency status or ability to pay.

Along with the EHIC benefit afforded to all EU nations, Finland also reimburses residents for some private healthcare costs, medicine purchases, and medical-related travel expenses. Prescription drug costs max out around $650 USD annually, limiting resident costs on their healthcare.

4) Costa Rica

Advantages: universal healthcare after 18 months, top-tier medical care, no out-of-pocket fees

Costa Rica operates the best healthcare system in Latin America; thanks to the high quality and low costs, the country has even become a popular medical tourism destination. Hospital facilities can be found across the country, but the most specialized are located in the Central Valley Region. Despite the high quality of care offered by public hospitals, they can be overcrowded and it’s not uncommon for patients to face long waiting periods and delays in procedures. For this reason, many expats prefer to use the private system instead, allowing them to select their GP and preferred hospital.

Costa Rica uses a universal healthcare system. Registration within the public system (the Caja) is part of the residency process; expats pay 7-11% of their income into this option each month, either direct or through their employer. This monthly payment is the only fee for public health medical treatment; all other costs are covered. Self-employed and retired residents pay into the independent worker plan (asegurado voluntario). This monthly contribution covers spouses and dependents, as well.

5) Switzerland

Advantages: universal healthcare, pre-existing conditions covered, lower out-of-pocket max, EHIC qualified

Switzerland operates a decentralized public healthcare system, requiring all residents to purchase insurance from private nonprofit insurers within three months of their arrival. According to the Commonwealth Fund, each of the 26 Swiss cantons (states) oversee their area’s health systems. Insurance plans are not sponsored by employers. These mandatory insurance plans cover GP and specialist visits, hospitalization, preventive care, maternity, and more. Deductibles and coinsurance requirements vary from canton to canton.

Standardized costs can be hard to predict in a country with 26 healthcare systems. Patients pay the full costs of most medical services up to their deductible, plus a 10% coinsurance and possible copayment. Insurance policies apply to individuals, requiring separate coverage for adults and dependents. While costs can vary per canton, the standard minimum deductibles for the public health insurance plans are ₣300 ($334 USD) for adults and ₣0 for kids.

While the Swiss healthcare system may be more complicated than other countries here, it still took the top spot for best healthcare system in the world in 2022. It uses the EHIC to make travel around the EU easier, covers pre-existing conditions. At $2645 USD out-of-pocket maximum for individuals, Switzerland comes in far under the Obamacare plans’ out-of-pocket maximums of $9100 USD for individuals.

6) Panama

Advantages: great end-of-life care, top-tier hospital, transparent rates, discounts for retirees

Panama offers several healthcare options that are more affordable than the U.S. health system. The government provides public and subsidized healthcare to some residents, while private insurance companies offer a variety of plans. For those who don’t have access to either of these options, the country also has an extensive network of medical clinics and hospitals that provide health services at reasonable out-of-pocket rates. If you have a pensionado visa or you’re of retirement age (55 for women and 60 for men), you can get discounts on those rates, too.

As a couple of examples of how care varies from the U.S., visit the Hospital Nacional or Hospital Punta Pacífica websites. There’s even a Johns Hopkins facility in Panama City, the U.S. gold standard in medical treatment. You’ll see transparent rate charts for gallbladder surgery, hip replacement, and maternity care. Most doctors in Panama trained in the United States, too, so their English skills should be solid. You can even make your appointments on WhatsApp.

7) Spain

Advantages: public healthcare access, pre-existing conditions covered under public plan, EHIC qualified

Spain’s population enjoys good quality healthcare, with public health initiatives providing an extra layer of security to those who need it most. Admission into Sistema Nacional de Salud(SNS), Spain’s public healthcare system, can take several months for expats who aren’t employed locally, making private insurance a draw for new residents.

Spain’s healthcare pricing is pretty direct, making out-of-pocket costs lower than the U.S. and relatively easy to predict. In fact, most medical services (ER visits, GP consults, hospitalization) are fully covered under the national health system. Private insurance may cover the expenses not included within SNS or for those who don’t pay into the public option. Some medications can be purchased at a pharmacy without a prescription, although there are restrictions.

As with Germany and Switzerland above, pre-existing conditions are covered by Spain’s public health system. It also offers the EHIC as part of the European Union, so your Spanish healthcare would cover you in the rest of those countries. Spain’s public healthcare costs about $65 USD/month for people under 65, while retirees pay about $172 USD/month.

8) Greece

Advantages: universal healthcare free to unemployed, little or no out-of-pocket fees, EHIC qualified

Greece operates a National Health System (ESY) which aims to deliver free and equitable health services to all. Its system uses a combination of public and private health service providers, with most expats using the private system. National health standards are generally high, though these can vary between the Greek mainland and surrounding islands.

Primary healthcare — including hospital outpatient, surgeries, and rural health centers — gets administered through ESY. Expat residents gain access to the free public system if they contribute to the Social Insurance Institute (IKA), a public company overseeing Greece’s social security. Both employed and retired expats can use the public system by paying into the IKA, though self-employed expats follow another plan.

With its universal healthcare plan offering minor out-of-pocket fees and EHIC participation, Greece extends a welcome invitation to the European Union.

9) The Netherlands

Advantages: comprehensive healthcare for all, long-term care funded by gov’t, EHIC qualified

The Netherlands uses a combination of public and private healthcare coverage to treat all residents. Here, the government funds all long-term health treatments, while private insurers manage short-term care needs. Short-term care, in this case, usually encompasses GP visits, hospitalizations, specialists, most prescriptions, maternity care, and ambulance services.

All legal residents in the Netherlands are required to carry private health insurance, which starts around $110 USD/month and $500 USD deductible. The Dutch government regulates the private market, ensuring minimum coverages, standards of care, and deductibles.

10) Portugal

Advantages: universal healthcare covers most needs, transparent fees, EHIC qualified

Overall, Portugal’s population enjoys good quality health care, with public health initiatives providing an extra layer of security to those who need it the most. Private insurance is encouraged in addition to the public option, as the public system has long wait times for elective procedures. Private insurance would also allow you to choose your physician.

Portugal’s universal health system covers all medical procedures, aside from dental care and cosmetic surgery. Public hospitals can be found throughout the country, while each municipality uses local health centers known as centros de saúde to provide primary medical care. You may have some service fees due at doctor visits and diagnostic exams; these are capped at $1,100 USD per year and can be deducted from your taxes.

With its universal coverage, transparent fee schedule, and EHIC participation within the EU, Portugal offers tremendous value to expats who make it their home.

11) France

Advantages: 70% of costs covered, transparent pricing, available after 3 months, EHIC qualified

France’s population enjoys good quality healthcare, with public health initiatives providing an extra layer of security to those who need it the most. It operates on a copayment system for the public option, covering up to 70% of your medical costs. Most people purchase protection mutuelle, or supplemental insurance, to cover the additional medical costs.

You can apply for a carte vitale, France’s national insurance card, after your first three months here. With its transparent pricing, English-speaking healthcare professionals and EHIC participation, France offers a welcome place to study, work, or retire.

12) United Kingdom

Advantages: universal healthcare after 6 months, most care is $0

The United Kingdom was the first healthcare system to be funded by general taxation. Free care is given based on need, rather than ability to pay fees or insurance. Thus, most medical care costs $0 at time of service. EHIC isn’t really used in the UK post-Brexit, though they do offer a replacement.

Public healthcare is free to all UK residents under the NHS system. This offer extends to non-residents, too, so long as they did not specifically travel for free healthcare. Once you’re a resident here, you’ll register with the NHS. Expats can access the NHS system after living in the UK for six months and paying the immigration health surcharge of £624 per year ($810 USD) with your visa.

13) Italy

Advantages: universal healthcare after 90 days, nominal fees, no deductibles, EHIC qualified

Italy provides universal coverage through its National Health Service, Servizio Sanitario Nazionale (SSN). SSN has offered urgent and essential medical service to undocumented people since 1998, while Italian citizens and legal residents have benefited from this system since 1978. Healthcare delivery is decentralized across 100 local health units, providing services ranging from primary care to mental health.

All legal residents in Italy have a right to public healthcare. Anyone staying in the country beyond 90 days is required to have coverage. Roughly 10% of the population carries additional private insurance, which may provide quicker care access, choice of specialists, and better amenities for elective procedures.

According to the Commonwealth Fund, Italy’s public insurance scheme doesn’t apply deductibles or charge fees for services like GP visits and hospital stays. Add in the country’s EHIC participation, and you’ll find a health system that takes care of its residents, citizen and expat alike.

14) Austria

Advantages: universal healthcare after 6 months, low service fees, EHIC qualified

Austria’s renowned public healthcare plan receives its funding through federal tax revenues. Payment into a health insurance scheme, public or private, is required for citizens and expats. Care is extended to all legal residents, mostly for free or nominal costs at time of service. Austria’s Ministry of Social Affairs, Health, Care, and Consumer Protection oversees both public and private schemes.

Austria’s universal public scheme covers healthcare, accidents, and pensions; it’s available to new residents after 6 months. Private health insurance is available, too, which may provide quicker care access, choice of specialists, and better amenities for elective procedures. The vast majority of residents use the public health option. The country’s EHIC participation and low service fees make this an attractive place for expats to work and retire abroad.

The United States is an immensely popular destination; it’s the land of opportunity for more than 50 million immigrants. For some American citizens, those opportunities are overshadowed by the high cost of healthcare and medical insurance.

If you’re struggling, we want to reveal something that you might not know you have—options. As a population, U.S. citizens don’t really move abroad like other countries. Our tendency to stay within our home country limits our perspective on how life could be different beyond our borders. If the U.S. healthcare system doesn’t work well for you right now, we hope you can find another health system that will.

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