Healthcare Systems by Country: 2026 Data on 30 Countries for Expats and Retirees

Written by Steffan Grund · Insurance specialist (Versicherungsfachmann BWV) · Updated October 27, 2026Facts checked: October 27, 2026

Key facts: healthcare systems at a glance (2026 data)

Which countries have universal healthcare?

There is no official list of "universal healthcare countries"; the WHO and World Bank instead score how well each country covers essential services, with the UHC service coverage index from 0 to 100. On that index (2023), 21 of our 30 countries score 80 or more, led by Canada (92), Australia and New Zealand (89), and the UK, the USA and Singapore (88).

A high index does not mean free care for everyone. The USA scores 88 because services exist and are widely used, yet it has no universal public scheme for residents under 65. Thailand scores 82 with a public Universal Coverage scheme, but foreign residents are not automatically part of it. That is why our table adds a separate column: can a non-working foreign resident actually join?

Healthcare rankings by country: which systems score best on the data?

Each ranking below is a plain sort of the dataset, so you can check it against the big table. We do not combine indicators into a secret score.

Highest UHC service coverage index

Lowest out-of-pocket share of health spending

Longest life expectancy and most doctors

Ties are broken on the unrounded figure (Japan 84.04 years ahead of Italy 83.95). Our "expat value" shortlist keeps countries with a UHC index of at least 80 and an out-of-pocket share of 20% or less: Thailand, Japan, France, Germany, United Kingdom, Ireland, Netherlands, Colombia, Uruguay, United States, Canada, Australia, New Zealand, UAE (14 countries). Several high-coverage countries miss only on the out-of-pocket rule, including Spain (20.9%), Italy (22.3%), Costa Rica (24.1%), Singapore (25.4%) and Portugal (28.2%).

What are the four types of healthcare system?

Health systems are usually grouped by who pays and who runs care. We use four simple labels; they are our classification, checked against the government share of health spending.

The government share of health spending (WHO GHED) shows the pattern: Japan (84.8%), Croatia (84.0%) and the UK (81.8%) sit at the top, while the Philippines (42.4%), Vietnam (44.3%) and Mexico (48.6%) rely heavily on private money, most of it paid out of pocket.

Can foreign residents join public healthcare in each country?

In 14 of the 30 countries a non-working legal resident has a stated route in; in 11 the route depends on permanent residence, work or an S1; in 5 we found none. The rules below come from our country fact sheets and GOV.UK guidance.

"Limited" means the rule names specific groups (permanent residents, workers, S1 holders, or holders of long work visas). GOV.UK pages for Ireland, Italy, Cyprus and the Netherlands date from 2021–2022; check the current rule locally.

What does each system type mean for expats?

NHS-style systems: residence opens the door, waiting decides the experience

In Portugal, any legally resident foreigner can get an SNS user number, and fees apply mainly to emergency visits without a referral. Spain lets residents buy in after a year through the convenio especial. Italy offers voluntary registration for a yearly fee. In these systems the challenge is rarely the door; it is waiting lists, language and finding a family doctor with space. Out-of-pocket shares are moderate to high in southern Europe (Portugal 28.2%, Italy 22.3%, Spain 20.9%), because dental care, some medicines and private consultations are paid directly. Read more in Retire in Portugal and the Portugal D7 guide.

Social insurance systems: you pay in, then you are covered like locals

Germany, France, the Netherlands, Japan, Croatia and Turkey require residents to be insured and charge contributions. France opens PUMa after three months of stable residence (see expat health insurance in France and the France retirement visa). Costa Rica makes CCSS registration a condition of residence (Retire in Costa Rica). Contributions are often linked to income, and co-payments remain (Croatia: 20%, capped per treatment).

Mixed systems: voluntary schemes with health checks

Mexico’s IMSS voluntary insurance and Panama’s CSS group B2 accept foreigners but screen health: IMSS is for people without pre-existing conditions, and the CSS requires medical exams. Thailand and Malaysia offer no scheme to join, so foreign residents pay at public or private hospitals. Out-of-pocket shares are high (Mexico 41.2%, Panama 40.5%, Malaysia 37.1%). See expat health insurance in Mexico, Retire in Mexico, expat health insurance in Thailand and the Panama Pensionado visa.

Private-led systems: insurance is the system

In the USA and the UAE, cover comes from insurance. The USA spends USD 13,473 per person (2023) and has an out-of-pocket share of 10.9%, because private insurance and public programmes pay most bills. The UAE requires employers in Abu Dhabi and Dubai to insure staff. For Americans leaving home, the bigger issue is the reverse: Medicare generally does not pay outside the USA; see health insurance for Americans living abroad.

Why is public access not the same as full cover?

Joining a public system gives you the same rights as locals in that one country, with the same co-payments, waiting lists and exclusions; it does not follow you when you travel or move. International private insurance fills the gaps that matter to a retiree who lives across borders.

Visa minimums are not good cover either. Thailand’s O-A asks for a sum of at least 3,000,000 THB a year, but a long hospital stay can exceed what a minimal policy pays. Compare tiers and deductibles on our international health insurance cost page, the expat health insurance guide and the Care Expat World plan overview.

Which retirement visas require health insurance?

Of the countries with a retirement or residence route in our data, Thailand (O-A), Portugal, Spain, France, Greece, Colombia and Ecuador ask for insurance, and Costa Rica requires CCSS enrolment. The Philippines, Panama, Mexico and Uruguay set no insurance rule. Cyprus (Category F), Malaysia and Indonesia do not list it on the official pages we read, and Italy asks for it only for the residence permit, not on the visa checklists.

• Thailand retirement visa: O-A insurance of at least 3,000,000 THB / USD 100,000 a year; a foreign policy needs the signed Foreign Insurance Certificate.
• Portugal D7: travel insurance with medical cover for the visa; UK pensioners can use an S1.
• Greece FIP: travel insurance for the visa, a private policy for the residence permit.
• France visitor visa: health cover for the stay; travel insurance is not accepted from UK applicants.
• Philippines SRRV and Panama Pensionado: no insurance rule, only a medical or health certificate.

The full comparison of income, age, deposit and residence rules is in retirement visas by country; the insurance rule of each route is in visa health insurance requirements by country, and remote-work routes are in digital nomad visas by country. Never assume an insurer’s policy will be accepted for a visa; ask the consulate and the insurer in writing first.

What changes for UK pensioners and US retirees?

UK State Pension holders who move to an EU country can usually register an S1, which gives state healthcare funded by the NHS on the same basis as locals. GOV.UK describes this route for Portugal, France, Italy, Greece, Cyprus, Germany, Croatia and the Netherlands, and Spain’s London consulate accepts a registered S1 for the non-lucrative visa. The S1 does not work in Thailand, the Philippines, Mexico, Costa Rica or other non-EU countries. Read how the S1 form works and which gaps remain with an S1.

Americans have no equivalent: Medicare generally does not pay for care outside the USA, and the US–France social security agreement, for example, has no health provisions. A US retiree abroad relies on the local system where it is open and on private international insurance.

Example: a 58-year-old American and a 61-year-old Briton

Linda, 58, from Arizona, is choosing between Portugal, Mexico and Thailand. The data shows Portugal with a UHC index of 83 and 5.85 doctors per 1,000, Mexico at 79 with an out-of-pocket share of 41.2%, and Thailand at 82 with only 0.54 doctors per 1,000 nationally. As a legal resident she could get an SNS number in Portugal or apply for IMSS in Mexico (14,850 MXN a year at 50–59, subject to its health questionnaire); in Thailand she would have no public scheme. For the Thai O-A she would also need a qualifying policy.

David, 61, from Leeds, receives his UK State Pension and compares Spain, Costa Rica and the Philippines. In Spain he can use a registered S1, which the Spanish consulate in London also accepts for the non-lucrative visa. In Costa Rica he must register with the CCSS, and the S1 does not apply. In the Philippines he could join PhilHealth, but the out-of-pocket share is 44.4% and the UHC index 69. He wants one policy that follows him if he changes country.

Home-country cover under Care Expat World applies only to EU or Schengen citizens, so neither Linda (USA) nor David (UK) would be covered on visits home.

Checklist: how to check a country’s healthcare before you move

• Look up the UHC index, out-of-pocket share and doctors per 1,000 in the table above
• Confirm whether your residence status lets you join the public system, and after how long
• Check the visa’s insurance rule: minimum sum, required wording, local or foreign insurer
• UK pensioners: ask NHS Overseas Healthcare Services whether an S1 applies to your destination
• US citizens: plan for Medicare not paying abroad, and decide about Part B before you leave
• List the gaps: co-payments, dental, pre-existing conditions, cover while travelling
• Get long-term international cover in place before the year you turn 65

Where can I read more about each country?

Still choosing a destination? Our best countries to retire page weighs healthcare against cost, climate and visas. For budgets, see the cheapest countries to retire.

How we built this dataset (methodology and data date)

Data date: all indicators were pulled from the World Bank’s World Development Indicators database on 27 October 2026 (database last updated 8 October 2026). For each country and indicator we took the latest year with a value; years therefore differ, and every cell shows its year.

• No invented values. Every country had all six indicators; where an access rule could not be confirmed, the cell says so.
• Rounding. Spending to whole dollars, shares and life expectancy to one decimal, doctors to two decimals; rankings use the unrounded values.
• Rankings are mechanical. Each list is a straight sort of one column; the "expat value" shortlist is a stated rule (UHC index of at least 80 and out-of-pocket share of 20% or less).
• Conflicts shown. Canadian waiting periods differ between sources; the table says so.

Where these facts come from

• World Bank, World Development Indicators (database updated 8 Oct 2026, pulled 27 Oct 2026): current health expenditure per capita, out-of-pocket and domestic general government shares (from the WHO Global Health Expenditure Database), life expectancy at birth, physicians per 1,000, UHC service coverage index
• UAE: Dubai Law No. 11 of 2013 and Abu Dhabi Law No. 23 of 2005 (health insurance); MOHRE basic health insurance scheme (from 1 January 2025); ICP “Issuing Residency Permit”, retired-foreigner documents (last updated 11 December 2024), read 28 October 2026
• GOV.UK living-in and healthcare guides for Malaysia (Jan 2026), Vietnam (Sep 2025), Italy (Oct 2022), Cyprus (Oct 2021), Germany (Sep 2024), Ireland (Oct 2021), the Netherlands (Oct 2021), Croatia (Apr 2024), Turkey (Dec 2025), Colombia (Feb 2026), Australia, New Zealand, the UAE and the USA (Dec 2025), Singapore and Japan (Feb 2026)
• Cyprus Health Insurance Organisation: GHS enrolment guide for non-Cypriot nationals (undated, republished by the German Embassy Nicosia; read 28 October 2026)
• Spanish Ministry of Health: special agreement for healthcare (convenio especial), and Community of Madrid procedure page (via search index)
• Services Australia: Medicare enrolment for permanent residents; New Zealand Ministry of Health: eligibility for publicly funded services (via search index)
• Japanese Ministry of Health, Labour and Welfare and city guides (Osaka, Nerima): National Health Insurance for foreign residents (via search index)
• Ecuadorian Social Security Institute (IESS): voluntary affiliation FAQ (via search index); HealthCare.gov: coverage for lawfully present immigrants
• Our country fact sheets: Thailand, Philippines, Mexico, France, Portugal, Greece, Panama and Costa Rica (embassy, health-ministry, PhilHealth, IMSS, CSS, CCSS and GOV.UK sources), and our retirement visas comparison (Spain, Italy, Malaysia, Indonesia, Colombia, Ecuador, Uruguay, Cyprus)
• Commonly reported (secondary, flagged in the table): Indonesia BPJS rules for foreigners, Uruguay FONASA and mutualistas, Canadian provincial waiting periods

Indicators describe whole populations, not what a foreign resident pays. Rules for foreigners change; confirm with the health fund or ministry before you move.