Healthcare abroad for expats: what WHO and World Bank health data show

What the WHO universal coverage index actually measures

The World Health Organization defines universal health coverage as all people having access to the full range of quality health services they need, when and where they need them, without financial hardship. Its main tracking measure is the UHC service coverage index, which combines 14 tracer indicators into a single summary on a 0 to 100 scale.

The index is built from four components: reproductive, maternal, newborn and child health; infectious diseases; noncommunicable diseases; and service capacity and access. WHO reports a global index value of 71 out of 100 in 2023, up from 54 in 2000. It also says about 4.6 billion people were not fully covered by essential health services in 2023, and 2.1 billion faced financial hardship from health costs in 2022.

Two cautions. The index measures coverage of essential services across a population, not the waiting time for a particular specialist. And it describes residents of a country; whether a newcomer is covered depends on the rules. We therefore use it for context and rely on three comparable indicators below.

Four ways countries organise and pay for healthcare

Wikipedia's overview of universal health care describes several models. In a Beveridge-style system, such as the United Kingdom's, the government provides care directly. In a Bismarck-style system, such as Germany's, mandatory contributions from workers, employers and governments are pooled in sickness funds, and the page says it is also used in parts of Europe, Israel and Japan.

In a single-payer system, a single public body pays for care, though delivery may be public or private. Canada, Finland, Portugal, Spain and Iceland are examples. Under mandatory private insurance, residents must buy cover from regulated insurers, as in the Netherlands and Switzerland.

The model matters to a newcomer because it decides how you enrol. In some systems you register with a public fund or a local authority; in others you buy a policy. Private insurance and employer cover can also sit alongside the public system. The rules are set by each country, so check the health ministry's pages in the country you are considering.

Life expectancy, out-of-pocket share and doctors per head, side by side

The table compares countries that often appear on expatriate shortlists and that we cover with city pages. We selected them for that reason, not for their health results, and list them alphabetically so that nothing implies a ranking. The figures are from the World Bank's World Development Indicators, using the latest year available for each indicator.

Life expectancy at birth is a broad outcome measure. It reflects diet, income, safety and public health as much as hospitals. Out-of-pocket spending is the share of current health expenditure paid directly by patients (the World Bank takes it from WHO's Global Health Expenditure Database); a lower share means less of the cost falls directly on patients. Physicians per 1,000 people measures supply, not distribution.

No indicator here measures quality of individual care or ease of access for foreigners. Read the numbers as context only.

What the table does and does not tell you

Spain, Switzerland, Italy and Japan sit at about 84 years of life expectancy, and Mexico at 75.3, with Thailand and Malaysia at about 77. That is a gap of roughly nine years across the group, but outcomes depend on many things beyond the health system.

Out-of-pocket shares range widely, from 9.2 per cent in France and 9.7 per cent in the United Arab Emirates to above 40 per cent in Mexico and Panama. A high share does not by itself say anything about the quality of care; it shows how much of the cost patients pay directly. Physician counts range from 0.5 per 1,000 in Thailand in 2021 to 5.9 in Portugal in 2022; the Thai figure is from 2021, an older year than most, so treat it carefully.

For readers considering Southeast Asia, Latin America or the Gulf, the table shows why people often compare insurers and hospitals individually, not just countries. For Europe, the best countries to live in Europe covers the wider picture, and best countries for expats adds a second dataset.

Questions to settle before you rely on a foreign health system

Coverage for a foreign resident is a question of status and rules, not of rankings. Governments publish guidance, and so do home governments for their citizens abroad. Read both, and ask an insurer in writing what a policy covers, including pre-existing conditions, repatriation and routine care.

Continuity of care, such as repeat prescriptions and specialist follow-up, is a question for your own doctor. We cannot advise on it, and this guide does not.

• Ask the destination's health ministry how foreign residents are enrolled, if at all.
• Ask any insurer to confirm in writing what its policy covers.
• Ask your own doctor how to handle records and prescriptions.
• Find out where the nearest hospital is to where you will live.
• Test a city with a month's stay before committing; see serviced apartments for relocation.

City pages to pair with this data

If you are narrowing a list, look at specific cities rather than countries: Madrid, Lisbon, Berlin, Tokyo, Bangkok and Mexico City are examples that appear in the table's countries. For a longer visit, long-stay apartments in Lisbon show how a month-plus format works. Country hubs include Spain, Portugal and Thailand.

Work patterns affect health too, and the best countries for work-life balance covers that angle.