Healthcare: the best systems for expatriates

In the European Union, a registered resident has access to the host country's public system on the same terms as its nationals. This is the case in Portugal, Spain, Italy, Greece and the countries of Central Europe.

Quality and waiting times vary considerably. The Lombardy system is reputed to be the best in Italy; the Portuguese, Greek and Bulgarian systems suffer from waiting times for specialists that push a large proportion of expatriates towards the private sector.

A local private top-up policy, generally inexpensive, is then enough to bridge the gap. This is the most comfortable and least costly configuration.

It does, however, require registration, which stems from employment or enrolment, not from residence alone.

Moving abroad also, in principle, ends membership of the French scheme, except in specific situations such as secondment or certain social security agreements. Joining the Caisse des Français de l'étranger (CFE) makes it possible to rebuild a French base cover, and is often combined with a local top-up policy.

Switzerland requires compulsory, individual health insurance, taken out with a private insurer by each member of the household, including each child. Its cost rises with age and is not deducted from salary.

This is the item French newcomers underestimate the most, because it has no equivalent in their home system: it is a visible, direct expense, not an invisible contribution.

Costa Rica, for its part, requires membership of its social security scheme, with contributions calculated on declared income. It is a recurring charge, and failure to pay it is one of the most frequent causes of a break in the residence process.

In return, both systems offer a high standard of care — world-class in the first case, high by regional standards in the second.

In the Gulf states, private health insurance is compulsory to obtain and keep a residence permit, and there is no public alternative for foreigners.

Facilities are of a high standard and waiting times short, but the cost of insurance rises steeply with age, and becomes prohibitive for a retiree.

This is why these destinations suit mid-career working people and are much less suited to retiring abroad — regardless of their tax regime.

Singapore and Hong Kong follow a similar logic: an excellent private sector, a public sector that is restricted or saturated, and a cost that rises with age.

Several destinations lack the technical facilities needed for major procedures. Vanuatu requires evacuation to Australia or New Zealand, the Philippines to Singapore or Bangkok, Cape Verde to Europe.

Insurance covering medical evacuation is then a condition for the project to be feasible, not an option. Its cost and the conditions that trigger it must be read in detail.

We do not publish premium ranges or rankings of healthcare systems: these data depend on age, cover and medical history, and we have found no official source that would allow them to be quantified without being misleading.

1. Check whether local membership is compulsory and whether the residence permit depends on it.
2. Examine how accessible the public system really is to foreigners.
3. Have the premium projected at ten and twenty years, not just for the first year.
4. Check pre-existing conditions and the guarantee of renewal before leaving.
5. Match the area of cover and evacuation to the project's actual geography.

The third point is the one that throws the most projects off balance. A policy that is attractive at fifty can become unaffordable at seventy, and changing insurer is then impossible because of the medical history accumulated. This item must be treated on a par with tax, and generally earlier.