Is healthcare ever really ‘free’? The short answer is no, although many countries do offer a number of healthcare services at little to no cost. As an expat, you may be entitled to some or all of these services depending on your status, but you can always avoid the potential headache of paying for healthcare costs individually by choosing international health insurance instead.
To help you decide where international health insurance will be most important for you and your family, we run through which countries offer universal healthcare, and why international health insurance still matters.
In this article
- 1/ Which countries have free healthcare?
- 2/ What’s the difference between free and universal healthcare?
- 3/ Which countries have the best free or universal healthcare?
- 4/ What’s the basis for the WHO’s listing?
- 5/ Is healthcare free for expats?
- 6/ Which European countries offer free healthcare for expats?
- 7/ Does Canada offer free healthcare for expats?
- 8/ Does Australia offer free healthcare for expats?
- 9/ Does the UK offer free healthcare for expats?
- 10/ Do countries with universal health care systems offer free healthcare to expats?
- 11/ Why do you still need health insurance?
Unfortunately, there’s no such thing as completely ‘free’ healthcare, at least not in the sense that 100% of medical services will be provided, free-of-charge, to anyone.
For instance, while many countries will provide healthcare to all citizens, they may still charge for services such as dentistry and mental health services, and the cost of prescription medications may need to be paid for by patients too.
However, there is such a thing as ‘universal’ healthcare. This is a system in which most services are offered free, or for a very low cost, to citizens, residents and perhaps even non-residents of that country. They are usually funded by individual taxpayer contributions but may come from other sources, such as corporation tax.
- Antigua and Barbuda
- Bosnia and Herzegovina
- Burkina Faso
- Costa Rica
- Czech Republic
- New Zealand
- Northern Macedonia
- Saint Lucia
- Saint Vincent and the Grenadines
- San Marino
- Saudi Arabia
- South Korea
- Sri Lanka
- Trinidad and Tobago
- United Arab Emirates
- United Kingdom
- Cabo Verde
- Cote d’Ivoire
- El Salvador
- Equatorial Guinea
- North Korea
- Papua New Guinea
- Solomon Islands
- South Africa
- Sao Tome and Principe
This is not to say that these countries will necessarily offer free or low-priced healthcare services to expatriates. Indeed, you may find that many of these countries charge non-residents for treatment. If you are planning on becoming an expatriate, it’s always best to do your research in advance to understand whether you may be in line for treatment fees.
Free healthcare and universal healthcare may sound like the same thing but they’re not.
Free healthcare relates to the cost of treatment and the phrase usually refers to healthcare that isn’t paid for at the point of treatment. A combination of taxes and other contributions from residents help to fund these ‘free’ systems. Hence, they are not strictly speaking ‘free’ to fund, but may still appear ‘free’ in the way they are distributed.
Universal healthcare relates to access to treatment. If a country’s healthcare system covers more than 90% or more of its citizens, the service is usually considered universal. Therefore, universal is not synonymous with ‘free’ at all.
The WHO’s original list was designed to rank 191 healthcare systems across the globe according to their efficiency. Countries were scored in a number of areas that contribute to a well-functioning healthcare system, including:
- a steady financing mechanism
- a properly-trained and adequately-paid workforce
- well-maintained facilities
- access to reliable information to base decisions on
Healthcare is never entirely free in any part of the world. Systems are funded by taxes or other contributions from residents and expats may be able to access those services in an affordable way.
You might need to make social security contributions, or show proof of private health insurance cover when applying for your visa, to then access public services. In some countries, such as France, it’s necessary to do both.
Many countries – for instance, Mexico – will also ask you to pay an annual fee to access public healthcare. The upfront costs often work out cheaper than paying for private treatment.
As we’ve already established, there’s no such thing as totally ‘free’ healthcare, but some countries in Europe offer treatment at very low costs.
In Germany for example, you can access public healthcare by paying 7.3% of your income towards a public insurance scheme, which your employer will match. It’s important to note however, that you’ll still need private health insurance. To apply for a visa or to register as a resident, you’ll need to show proof of cover, which can be arranged through a German employer.
Unfortunately, Canada doesn’t offer free healthcare (at the point of treatment) to expats. You’ll need to arrange comprehensive medical insurance before you enter the country to make sure you’re covered.
A publicly funded health system called Canadian Medicare is available to all citizens and permanent residents.
Australia uses a half-and-half healthcare system. Treatment is free at public hospitals, but outside of these establishments you will be hit with a price tag. Australia does have a universal public health insurance programme known as Medicare, but most Australians still choose private health insurance. Expats living in Australia with a foreign passport should be covered for some treatments, but should still buy comprehensive medical insurance to cover a wider range of illnesses and ailments.
The Australian government encourages people to buy private health insurance by offering tax rebates.
All UK residents have access to free treatment through the National Health Service (NHS). This service is funded by individual taxes through a system called ‘national insurance’. A very small percentage is also paid for by patient charges on things like prescriptions and dental treatment.
Visitors from abroad may be charged for NHS services depending on the length and purpose of their residence in the UK, rather than their nationality. Treatment in Accident & Emergency departments and at GP surgeries remains free for all.
Some do, and some don’t. It’s always best to check the local healthcare situation in a country you plan to visit or stay in before you go, to be sure what your rights will be when you arrive.
Funding systems vary by country too. In fact, we can divide these into four models:
- single-payer healthcare
- sickness funds
- national health insurance models
- out-of-pocket models
Even in countries offering low cost and universal healthcare you may need private health insurance for one of, or both, of the following reasons:
- to apply for a visa or register as a resident in a given country (as is the case in countries such as France, Italy and Spain)
- to pay for treatments not covered by a country’s local healthcare system
Even in countries with free or universal healthcare models, expatriates should consider an extra level of private medical insurance in order to ensure they are not caught unawares by the cost of treatments that fall outside of their ordinary entitlements.
Furthermore, international health insurance will also cover you throughout your entire area of cover, meaning if you travel to, or live temporarily in other countries during your period of cover, you will still be protected. And, by choosing a policy that includes medical evacuation (Medevac) insurance, you can guarantee that if you need urgent medical treatment that isn’t available locally, we’ll organise your evacuation to a location where treatment is available.
In short, international health insurance is the best way to guarantee you and your family will always be able to access high-quality healthcare, anywhere in your area of cover, despite any local restrictions.
Don’t take your chances – choose international health insurance wherever you go
No matter how universal the healthcare system in your new home country, anything could happen. And, as an expatriate, it can be hard to know where your rights begin and end when it comes to accessing healthcare. That’s why it’s important to choose a comprehensive health insurance policy that guarantees you and your family access to high-quality healthcare without the burden of high immediate costs.
At William Russell, we offer international health insurance that covers you for everything from minor injuries to long hospital stays to take one more thing off your mind. Speak to our award-winning customer service team today to see if our policies could be right for you.