Top 10 countries in the world for expat health and well-being

A blog post I wrote for Expat Assure.

Thinking about relocating to a new country? Choosing to start a new life abroad is a big decision: one best made when armed with insider knowledge about the top countries for expat healthcare.

International healthcare is one of the most important aspects of expat life, and is a top priority for individuals and families alike when thinking about moving abroad. Whether the healthcare system is similar to that in your native country or you are expecting a culture shock, an advance knowledge of the systems in place and what to expect from the quality is key to minimising stress and deciding whether international health insurance is necessary.

Quality of expat healthcare is a difficult thing to rank, but who best to offer an insight into the reality of health and well-being in international destinations than expats already living and experiencing life abroad? The Expat Insider survey, by global expatriate network InterNations, is one of the largest expat surveys in the world. For the third year in a row it has offered up unique insights into what it’s like moving, living and working abroad in 67 countries globally. With over 14,000 respondents representing 174 nationalities, the survey delves into a vast range of topics: from working abroad and personal finance to ease of settling in and quality of life.

The survey results uncovered some eye-opening truths about the realities of expats’ experiences. The newly created Health & Well-Being subcategory falls under the survey’s Quality of Life Index, and has its own ranking based on participants’ satisfaction when it comes to both emotional topics such as happiness, and factual data such as cost of healthcare in their new (or perhaps not so new) country.

10. Spain

The country renowned for its sunny weather, strong expat communities and rich culture makes the top ten thanks to the strengths and affordability of its public healthcare system, the ‘Sistema nacional de salud’ (SNS). The system is effective with a large network of hospitals and medical centres throughout the country. 34% of respondents to the Expat Insider survey consider Spain’s healthcare to be of excellent quality, while 39% claim it is also very easily affordable (compared to global averages of 23% and 21%, respectively). Children’s health is also rated positively in Spain: only 3% of expat parents give it an overall negative rating, compared to the global average of 12%.

The SNS is mostly financed through taxes, and healthcare in Spain is free for basic care (consultations with SNS doctors) and emergencies. Ambulance services are also, in general, free, but for outpatient medication a contribution is necessary, usually between 10% and 60%, depending on your income and situation. You will be covered by the SNS if you pay national insurance/social security contributions in Spain, and it is compulsory to register. If you are an expat in Spain but don’t pay taxes (for example if you are retired), you will be entitled to healthcare on the SNS after 12 months of residency.

Spain’s downfall is similar to many other European healthcare systems: the waiting periods can be long for specialist appointments or non-urgent hospitalisation. Dental and optical care is not covered by the public system, and choice of GP is limited to the area where you live.

Expats living in Spain have three choices for their health cover: to be covered only by the SNS, to top up with a Spanish private medical insurer, or to be covered by an international healthcare policy. The latter will allow you to be covered in Spain as well as other countries, include dental and optical coverage, and enable you to see the doctor of your choice without being limited to an insurer-approved network. Visit our Spain destination guide to find out health statistics, examples of private medical costs and practical information. To find out more about International health insurance please visit our Health Insurance page or to find out about finance protection please visit our Protection page.

9. Costa Rica

The World Health Organization frequently places Costa Rica in the top country rankings in the world for long life expectancy. It isn’t difficult to see why: at the heart of Central America, nestled between the Pacific on one side and the Caribbean on the other, the country’s sandy beaches, glorious climate and biodiversity are complemented by a world-class infrastructure. Costa Rica’s healthcare draws tens of thousands of healthcare tourists from all over the world each year due to its high quality and low cost. Private healthcare is affordable and widely available, especially in facilities in San José, Costa Rica’s capital, where many doctors and nurses speak English. However, having a private health insurance in place would be essential in order to have the medical expenses covered.

Expats in Costa Rica can take advantage of the benefits of the country’s healthcare system through the universal state-provided ‘Caja Costarricense de Seguro Social’, known as ‘Caja’ for short. Those living in the country can access the public healthcare plan by paying small income-based contributions, which is subsidised by the state through Costa Rican Bureau of Social Security (CCSS). Although as with many other countries’ state healthcare coverage, only designated hospitals and clinics will treat you (find a list here). If you opt for ‘self pay’, for which you do not have to hold residency, you can visit a doctor for around $25 to $50 USD.

8. France

With its cafe culture, peerless cuisine and magnificent countryside landscapes, France offers so much more than escargots and baguettes. As a popular expatriate destination, people move to France seeking a better quality of life, with its strong infrastructure and healthcare system as pulling factors. The quality of healthcare is rated in a positive light by 83% of expats surveyed, and 40% of respondents consider its affordability to be very good.

If you have registered as a resident in France (which you should do within three months of your arrival), you can register for the French social security system, which includes healthcare, via your local CPAM (Caisse Primaire Assurance Maladie) office. If you are working, speak to your employer, who will register you with the social security system.

Generally, medical expenses in France need to be paid as they occur, and are then reimbursed depending on your level of coverage. A large percentage of medical costs are reimbursed when you are subscribed to the French social security system (up to 70% for GP appointments or specialist consultations, and up to 80% for major surgeries – although there are exceptions depending on your circumstances).

7. Germany

With the fifth largest economy in the world, it’s no wonder Germany was ranked as one of the top rated places to find a job as an expat, while also hitting near the upper tiers for general living standards. With widespread access to healthcare, short waiting times and modern facilities, the German healthcare system has a strong reputation as one of the best in the world for expats. Parents need not worry: more than half the expats raising children in Germany (52%) are totally satisfied with their children’s health.

The downside, however, is that medical costs are high, so health insurance is obligatory for expatriates to avoid any financial disasters. If you will be working or studying in Germany, health insurance is mandatory, so you will not be able to start your job or course (or apply for a residency permit) without proof of it. Contributions to statutory insurance are split equally between employer and employee. Find out more about statutory insurance in different languages at the Federal Ministry for Health and Social Security website. In most cases, international health insurance will not be compliant for Germany and it is advisable to take out a local plan to ensure you have the coverage you need.

“Copenhagen” by John Anes is licensed under CC BY 2.0

6. Denmark

Expats living in Denmark pay very high taxes, but in return enjoy a high quality of life, reflected especially in the country’s healthcare statistics and patient satisfaction. It is a state medical system financed mostly through taxes, with the aim to provide universal, free and equal access for all. Free emergency treatment is also available to visitors from every other country.

All Danish residents are entitled to free treatment at health centres and hospitals (the majority of which are state-owned, so if you go to a private hospital you will have to pay). Expats living and working in Denmark can register as a resident with the Civil Registration System (CRS) to reap the benefits from the health insurance system. After which, you will receive a yellow card proving your entitlement to treatments and services.

A practical bonus is that the majority of Danes speak English, so it isn’t likely that you will struggle to find a doctor, nurse or dentist who speaks your language.


5. Israel

Despite Israel’s geographic location in a volatile area, this small country has a longer life expectancy and lower infant mortality rate than many western countries. With an efficient, universal system and high standards of care, Israel sees basic healthcare as a fundamental right. All residents are required to contribute: if you are working, a portion of your salary (around 5%) is paid into the National Insurance Institute, which finances the system.

In an emergency, Israeli law requires hospitals to accept all patients, regardless of their health insurance. If you fall ill and lose out on wages, it is possible to have up to 75% of your wages reimbursed. Supplemental insurance packages are popular in Israel, which top up the standard coverage. Perhaps surprising to some, family well-being is another positive in Israel. The country is ranked first for children’s health in InterNations’ Family Well-Being subcategory, with 56% of expat parents saying it is very good.

“Maiko” by Robert Young is licensed under CC BY 2.0

4. Japan

With the highest life expectancy in the world, the island nation came in at third place overall for expats’ quality of life, thanks to its strong transport infrastructure and peacefulness. Expats also specifically rated Japan’s healthcare very highly, with 82% scoring its medical care favorably, compared to 62% worldwide. Over three-quarters are also pleased with the affordability of healthcare, due to strict government regulations on costs to keep affordability a priority, and 31% of respondents think it is very good (ten percentage points more than the global average of 21%).

The National Health Insurance (NHI) in Japan usually covers 70% of the costs for most common medical expenses, and is funded by contributions from employees, employers and the government. All Japanese citizens under 75 years old are eligible for NHI coverage, as well as expats who have lived there for over a year. For the first year, to ensure you are not without cover, you can opt for a private (international) insurance to cover any eventual medical costs. The NHI packages cover hospital, primary, and specialist ambulatory and mental health care, home care services by medical institutions, hospice care, approved prescription drugs, physiotherapy, and most dental care.

3. Finland

This Nordic country comes in at third place due to its excellent three-level public health system, funded mainly by taxes. 66% of expats considered the healthcare standards as an advantage to their move, three quarters rate the quality of healthcare positively and 71% feel the same about its affordability, compared with just 55% of expats globally. The quality of the environment is also rated extremely highly by expats in Finland, with not one respondent having anything negative to say about it. Bed space available in public hospitals is high, and waiting lists for GP appointments is short: patients must be attended to within three working days.

Primary, secondary and tertiary care are covered by the state scheme, and you will be required to start contributions after four months of living in Finland. You will then be automatically entitled to free medical care in hospitals and public health centres, as well as payments towards prescriptions, dental care and even travel costs relating to medical treatments.

2. Taiwan

Taiwan ranked in the top ten for every individual index in the InterNations survey, but strongest in the Health and Well-Being category, showing that expats are highly impressed with the quality and affordability of the country’s healthcare, earning it a respectful second place. A staggering 94% of expats state they are happy with the quality of medical care, and 63% think the affordability is very good, compared to a global average of 21%.

Taiwan’s compulsory system, the National Health Insurance (NHI) provides equal access to all citizens and registered foreigners, covering 99% of the population, and is paid for by taxes and some government supplements. Medical care is cheap for expats, as you must enroll in the system with an Alien Residency Card, giving you access to the country’s world-class medical benefits such as doctors consultations, dental care and emergency care. Your employer will register you from the day your employment starts, but if you are not working, you must apply after four months of living in Taiwan. The country has invested in new technology and the medical card you are given is fitted with a chip, so your medical record can be accessed by practitioners wherever you go. Bear in mind, enrolling is mandatory so you may be fined for not joining.

But Taiwan’s healthcare system isn’t without its flaws: currently, babies born in Taiwan to non-Taiwanese parents are only covered by their mother’s NHI for two months after birth. Thereafter, they are not entitled to state health coverage until six months after they are born, meaning a four month gap where the parents will have to foot the bill for any illnesses. Vaccinations are covered by the government, however.

1. Austria

“Gipfelweg” by Waldemar Merger is licensed under CC BY 2.0

Expats deciding to move to Austria can rest assured that they will enter into one of the best healthcare systems in the world. Austria hits the number one spot as the top country for expat healthcare and well-being, with the most reliable, affordable and efficient offerings. More than four in five (82%) rate the quality of medical care positively compared to a global average of just 62%, and a similar percentage (79%) think Austrian healthcare is affordable.

Expats living in Austria must enroll to join the other residents and citizens of Austria in being entitled to free access to basic healthcare through tax contributions, with different payment scales depending on income and employment type. Treatment in public hospitals, medication, basic dental care and some specialist consultations are part of the system’s offerings.

The quality of the clean Alpine air and water is also a factor in expats’ positive ranking of Austria, with an astonishing 96% rating the environment positively. None of the expat parents surveyed are completely dissatisfied with their children’s well-being, while 87% are satisfied with the health and safety of their kids.


In general, expats often have three choices for their health cover:

• The first option is to be covered only by the public system of the country (in some cases this is obligatory)
• Secondly to top up with a local private medical insurer (but this will only cover you in your expat country)
• Lastly to be covered by an international healthcare policy. This will allow you to be covered in your expat country and your home country, as well as other countries around the world, as the zone of cover is often worldwide either including or excluding the USA. A growing number of people feel more at ease with buying international health insurance due to the fact that they travel frequently for business and leisure, but also because medical treatment is sought abroad to benefit from the best quality of care and expertise available for certain medical conditions.

An international health insurance policy also offers a more comprehensive cover and will often include dental and optical coverage, plus it will give the flexibility to see the doctor of your choice without being limited to an insurer-approved network. If you would like to insure yourself and your family more fully, Expat Assure can provide impartial advice on international health insurance. We also can help you to find the best life insurance and income protection. To find out more, visit our Protection page. Visit our Destination Guides for more information on international healthcare and health insurance for expats.

Is there a “right way” to treat people suffering with depression?

A piece I wrote for Expat Assure for World Health Day 2017.

Mental health doesn’t only affect the sufferer. We gain expert advice on how family and friends should help support a loved one, while taking care of themselves too.

Depression is the single largest contributor to ill health and disability globally. Over 300 million people are estimated to be suffering from depression, which is equivalent to 4.4% of the world’s population. The estimates have been released by the World Health Organization (WHO) in the lead up to World Health Day on 7th April. The aim of the day, which this year is centred on the theme of depression, is to promote a better public understanding of the ‘invisible’ condition and push more people to seek help.

WHO’s decision to shine a spotlight on the issue is a relief for the one in five of us who will experience depression at some point in our lives, as well as the many people with loved ones suffering from depression and anxiety disorders. Campaigners, charities, mental healthcare specialists and researchers have long been calling for more prominence in the treatment and understanding of mental health. WHO, along with many other charities and organisations, hopes to inform and educate as many people as possible about mental health disorders, as well as the ways people can seek support or help those suffering.

Mental health is determined by a range of socioeconomic, biological and environmental factors. Depressive and anxiety disorders are the two main categories for common mental disorder diagnoses, with the severity, symptoms and duration varying from person to person. These disorders are typically characterised by persistent sadness, loss of interest or pleasure, feelings of low self-worth and disturbed sleep or appetite, with severe symptoms including suicidal thoughts and self-harm.

As diagnosable health conditions, the feelings that mental illness sufferers experience are far removed from the passing negative emotions of sadness or stress that most people may experience in life. Mental illness can have implications on a person’s relationships, lifestyle and ability to cope with their usual daily life, meaning friends and family of those suffering are often left unsure of what actions to take or how to emotionally support their loved ones.

Depression can strike at any time and affects people of all ages and from all walks of life, and the number of people suffering from mental health disorders is increasing. Depression is the major contributor to suicide deaths, and someone dies by suicide every 40 seconds somewhere in the world. Lack of support for people with mental disorders, coupled with stigma, prevent many from accessing the treatment they need to live healthy, productive lives. But there are effective treatments for depression whether through medication, talking therapy, or a combination of the two.

Despite the existence of various treatments as a proven way to alleviating symptoms, WHO estimates that nearly 50% of people with depression do not get treatment, even in high-income countries. A major barrier to accessing care is the social stigma associated with mental disorders. Tackling stigma through education is a vital target of UK-based mental health charity SANE.

Along with the scientific and psycho-social research the charity conducts into mental illness and its consequences, SANE implements community and school-based programmes and promotes access to help through the Black Dog Campaign: named after a bygone metaphor for depression referred to by Winston Churchill and ancient Roman poets. However, their fresh and forward-thinking approach to mental health is anything but old-fashioned. The ongoing campaign aims to increase visibility and reverse prejudice as well as encourage people to seek help rather than suffer in silence. SANE provides confidential, specialist emotional support and expert information to anyone affected by mental illness, including the family, friends and carers of those suffering.

For many people, coping with symptoms of a loved one’s mental illness can be challenging, and may leave them feeling helpless or frustrated. “Mental illness can make relationships difficult,” says Adrian Garcia, leader of the Black Dog Campaign. “The person who is suffering might push away those closest to them. This can be particularly tough for loved ones, as they just want to help. It sometimes takes perseverance, as recovery can take time, but have patience, and keep trying.”

Depression and anxiety can manifest in many different ways, and it is helpful to learn as much as possible about a diagnosis to better understand what an individual is going through, as well as how treatments and medications can help. If you are concerned about someone’s mental health but they are feeling unwilling or anxious about seeing their GP, encouraging them to go and offering to accompany them might be the push they need to seek help.


Reassure your loved one that talking about what they are feeling, whether to you or to a professional, can help on the journey to treatment and recovery. Adrian advises finding an appropriate time and place to talk to the person you are worried about. “Make it clear that you want to help and you will listen to them without judgement,” he says. “Everyone’s experience is so unique, but for a lot of people, if they don’t talk about their mental illness their negative feelings can become internalised, and they can magnify. If they don’t talk about it, they aren’t going to get help. Making yourself available as someone they can trust is an invaluable way of showing support.”

Advancing the public understanding of the realities of mental health disorders is a key focus for the Black Dog Campaign. “The most important thing is for a person not to be denied their suffering. That can take a lot of different forms, but shrugging it off as ‘just needing to cheer up’ is damaging. Acceptance of mental illness as a serious condition is vital,” Adrian says. “The stigma that mental illness is associated with scary Victorian asylums: that’s changing. More people are aware that it comes in many different forms, and it can develop from something physical, biological or psychological.”

“There can be hesitation about how to act around someone suffering with depression, and a lot of people’s worries stem from not knowing what to say,” Adrian says, “But actually, saying something is a lot better than saying nothing. Any form of mental illness can be incredibly isolating, so staying in touch, checking how the person is doing, and showing you care can be of great comfort.”

Whether the support you are offering is emotional encouragement or helping with everyday practical tasks, it’s crucial that you take care of yourself too. “Providing this support can be emotionally overwhelming,” says Adrian, “So try to find ways to relax and continue doing things you enjoy. You need to consider your own support needs, especially if you are caring for someone full-time who is suffering from a mental illness.”

Many people find it helpful to attend support groups for those affected by a loved one’s mental illness. It gives the opportunity to meet others in similar positions and help you realise you are not alone in your situation. It can be helpful to share experiences with those who may be going through similar feelings that you are, as well as gaining ideas of what other people have found helpful to them.

SANE helps 750,000 people per year, all without government funding. Adrian and the rest of the team have high hopes that soon, mental conditions will be perceived in the same way as physical conditions, and will hold the same importance in terms of priority, range of treatments, research, funding and public attitude. Adrian says: “Physical health has been researched and funded for hundreds of years, whereas mental health is a very recent interest in terms of research. So we think mental health should be given a boost in funding to have at least the same as physical health, so it can catch up!”

Only 3% of government budgets, on average, is invested in mental health (WHO estimate). Economically, investment in mental health makes sense. A WHO-led study on future health outcomes showed that in 36 low, middle and high income countries, the current low levels of both access to mental healthcare and recognition of mental illnesses would be predicted to result in a global economic loss of a trillion US dollars per year. This amount would be incurred due to people out of work through mental illness, employers suffering financially through absenteeism and low productivity, and governments’ welfare expenditures. A strain is also put on healthcare systems, as depression increases the risk of substance use disorders and diseases such as diabetes and heart disease. With better access to mental healthcare and, therefore, a vastly increased number of people in employment, every US dollar invested in improving mental healthcare has a return of four dollars.

SANE offers confidential emotional support services from professional staff and trained volunteers. Specialist knowledge, emotional support and information is available to anyone affected by mental illness, including family, friends and carers. If you think a person is in immediate danger, seek professional help from the emergency services, a crisis line, or a healthcare professional.

Contact SANE:
Helpline: 0300 304 7000 from 4:30pm – 10:30pm every evening
Textcare: Allows you to arrange for messages of support at times that are right for you
Support Forum: Available 24 hours a day to share or read experiences with other members and give and receive mutual support
Social media: Facebook and Twitter communities are a good source of support and sharing
Write to SANE at: SANE Services, St. Mark’s Studios, 14 Chillingworth Road, Islington, London, N7 8QJ

Contact Samaritans:
Call Samaritans on 116 123 any time of day or night. The service provides confidential emotional support for people who are experiencing feelings of distress, despair or suicidal thoughts.
Visit Samaritans website
Social media: Facebook and Twitter

Follow Adrian Garcia on Twitter: @cicbdc

Opinions expressed are those of the individual and do not necessarily reflect those of SANE.