Is Free Healthcare a Possibility for International Citizens or Travelers?
They say that the best things in life are free – but does that really apply to healthcare? For people in some countries, the idea of free healthcare seems too good to be true. But there are many countries where citizens or residents never see a bill for the health care they receive. While it may be free for them (and it isn’t exactly free – more on that below), it’s not necessarily free for the traveler. In fact, it can be very expensive.
And if you are moving to a country with “universal healthcare,” that means it’s free, right? Again, not necessarily! While residents don’t see a healthcare bill in some countries with universal healthcare, in other countries with universal healthcare, they may incur significant costs. It depends on how the system works. Here’s what all travelers and expats should know about countries with free or universal healthcare.
Is “Free” Healthcare Really Free for Foreigners Abroad?
“Free” healthcare isn’t actually free. Healthcare that is provided by government agencies is usually funded by citizens in one way or another. The country’s healthcare budget may come directly out of their taxes, or it may be funded through payroll taxes which affect a citizen’s take-home pay. Savvy travelers know not to make offhand remarks about how lucky local residents are to have “free” healthcare in their country. You never know when you might get a sarcastic remark about how their tax bill didn’t seem so free!
Furthermore, in many countries with universal healthcare, patients often pay a small fee or deductible each time they visit the hospital or doctor. Sometimes patients have to pay in advance and then submit reimbursement forms to the government. Patients may even have to pay for government-mandated insurance. Therefore, free healthcare often does require money.
Finally, while citizens or residents may only have to pay a small fee, visitors who are not part of the country’s medical system pay far more. While the United Kingdom’s NHS is known for providing free care for its citizens, the cost of a hospital bed for non-residents is $1,125 a day, which is close to the cost in the USA. It’s one reason that many expats have global medical insurance.
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Understanding the Difference Between Free and Universal Healthcare
Free healthcare is different from universal healthcare. The terms are often used interchangeably, but they are not synonymous.
- Free Healthcare means that all citizens receive health care without having to pay for services.
- Universal Healthcare means there is a health care system that provides coverage to a high percentage of citizens. How high? Some analysts require 99% of citizens and residents to be covered for a system to be called universal, while others set the threshold at 90%. Under the latter analysis, the United States qualifies as a country with universal health care.
Both of the above systems have subsidized elements that are paid for with citizens’ taxes.
Which Types of Health Care Systems Give Free or Universal Healthcare?
There are four basic frameworks countries use to deliver health care. While the details may be different, most systems fall into one of the below categories – although the United States has elements of all of them.
Out of Pocket
Patients pay money to service providers in order to get care. Insurance is limited or nonexistent. This system is neither free nor universal. Cambodia, Chad, Nigeria and Armenia are just a few countries that use this system.
National Health Insurance
If you are thinking of a country with free healthcare, you may be thinking of a country with a National Health Insurance system, also known as “single-payer.” In this system, health care is generally provided through private facilities, but health care bills are paid by the government. In some countries using this system, the patient also has a small copay. Canada, Taiwan and South Korea are a few of the countries that use this system.
The Bismarck Model
Like in the National Health Insurance model, most health care facilities are private. But citizens are required to buy health insurance, which is heavily regulated by the government and must provide certain benefits. Usually, health insurance is non-profit and paid for through payroll deductions or payroll taxes. Low-income people may receive subsidies for health insurance from the government. This is the system Germany, France, the Netherlands, Japan and other countries use to deliver universal health care.
The Beveridge Model
This is the other system that provides what people think of as free healthcare. Like in the National Health Insurance model, the government uses taxation to pay for health care. Unlike the National Health Insurance or Bismarck models, most medical facilities are owned and run by the government. The most famous Beveridge health care system is the NHS in the UK, which was designed by William Beveridge himself. New Zealand, Cuba, Hong Kong and Spain are also among the many countries that use this system.
Public health care does not mean perfect health care. In some countries with government-funded health care, the majority of citizens purchase supplemental medical insurance to get faster, higher-quality care from private providers.
Where Can You Find Free Healthcare?
Only one country offers healthcare that is free for everyone: Brazil. The constitution defines healthcare as a universal right. Anyone in the country, even short-term visitors, can get health care for free.
According to Hudson’s Global Residence Index, all but 43 countries in the world offer free or universal healthcare to at least 90% of citizens. However, the standards among these countries can vary widely. The list includes Norway, one of the healthiest countries in the world and the first country in the world to introduce free healthcare in 1912. But it also includes the Central African Republic, which has one of the lowest life expectancies in the world and very few health care providers.
List of Countries With Universal Health Care Systems
The countries listed below have universal healthcare, defined as providing nearly 100% of citizens or residents with health coverage in some form. In many of these countries, employers and individuals share in the cost of healthcare through contributions, cost-share arrangements, copays, and other related fees. However, the goal of these programs is to provide universal care, which makes healthcare as affordable and accessible as possible for the largest number of people.
Some of these countries also have systems in which the government rather than the patient pays the bills for certain care; in those cases, we have noted which elements of health care are free for patients.
- Albania: All citizens have a constitutional right to health insurance. However, due to a shortage of medical workers, there is an informal system of out-of-pocket payments for services.
- Algeria: The healthcare system uses a National Health Insurance model. Hospital care is free for residents. The CNAS insurance program for salaried workers and their families covers most of the population. Non-salaried workers are covered under CASNOS, while people who don’t work are covered under the National Unemployment Insurance Fund.
- Argentina: All citizens and residents of this country can get free healthcare at public facilities.
- Australia: The Medicare system runs on a National Health Insurance model. Medicare provides free hospital care for all Australian citizens, New Zealand citizens and permanent residents that are enrolled in the program.
Learn more: Healthcare System in Australia
- Austria: Austria uses a Bismarck-style health care system to deliver universal health care. Health insurance is mandatory for anyone who will be in the country for more than six months.
- Bahrain: Previously this country used the Beveridge model, but they are currently shifting to a National Health Insurance model. Citizens will receive free insurance while expat residents will be required to pay for a portion of their insurance.
- Belgium: Another European country using the Bismarck model, Belgium has relatively high out-of-pocket costs for a European country.
- Bhutan: The country’s constitution requires free healthcare for all citizens. Tourists can also get free healthcare at some facilities. However, health care facilities are limited.
- Botswana: Hospital care, lab tests and medications are all free for citizens so long as they are done in a public facility.
- Brazil: Any citizen, resident or visitor is eligible to receive free healthcare through Brazil’s publicly funded healthcare system, Sistema Único de Saúde.
- Brunei: Healthcare here is free for citizens and permanent residents.
- Canada: When Americans think of free health care they often think of Canada. Canada uses a National Health Insurance model, and health care is run by the individual provinces and territories. All health care systems have to cover certain hospital care, lab tests and doctor visits. But beyond that, each province or territory differs significantly.
Learn more: Canadian Health Care System
- China: There are three insurance programs that combined cover over 97% of citizens. Most services require copays.
Learn more: Healthcare System in China
- Costa Rica: All citizens and residents must pay a premium to be part of the Caja Costarricense de Seguro Social (CCSS) insurance program. Healthcare is free at the point of service.
Learn more: Understanding the Costa Rica Healthcare System
- Croatia: All residents must join the mandatory health insurance program and have small co-pays when they receive healthcare.
- Cuba: All citizens of this country receive free healthcare at government-run facilities.
- Cyprus: GeSY is the national health insurance program in Cyprus. Citizens and permanent residents can enroll. They receive a limited number of free primary care visits per year.
- Czechia: All eligible residents must purchase a health insurance plan. Patients pay a small fee at the point of service.
- Denmark: The government automatically enrolls all residents in the national health insurance program. Members of the program receive free healthcare.
- Finland: This country runs on a unique Beveridge model, in which most health care is provided by the municipality. All permanent residents, whether or not they are citizens, may enroll in the Finnish health care system.
Learn more: Healthcare System in Finland
- France: Citizens and people residing in France for more than three months must sign up for the French healthcare system. Most services require limited patient copays.
Learn more: French Healthcare System
- Germany: The originator of the Bismarck healthcare model, Germany requires all residents to purchase a non-profit “sickness fund,” which is a type of health insurance.
Learn more: German Healthcare System – GKV
- Greece: Recently Greece moved from a Bismarck model to a National Health Insurance model of healthcare system. However, Greek residents still report significant out-of-pocket costs.
- Hong Kong: This special administrative region of China has a public system in the Beveridge model, as well as a robust private system. Most health care in the public system requires copays.
- Iceland: Iceland’s healthcare system uses the Beveridge model. Patients who use the system must pay limited fees at the time of service.
- Israel: The 1995 National Health Insurance Law established universal healthcare in Israel. Patients have seen increasing copays for services.
- Italy: The SSN gives patients free primary care visits and hospital care. But specialist visits, tests and prescription medications in Italy require copays from all patients.
Learn more: Healthcare System in Italy
- Japan: Anyone residing in Japan for more than three months must be enrolled in a health insurance program. The government assigns an insurance plan to a resident rather than residents choosing a program. All services require copays.
Learn more: Japanese Healthcare System
- Kuwait: While Kuwait offers free health care for its citizens, the wait times are so long that many residents have to go to a private provider.
- Luxembourg: Luxembourg runs on a National Health Insurance model. The government pays some costs directly to the provider, but in many cases, patients must submit their bills for reimbursement. Patients also have some out-of-pocket costs.
- Macau: All citizens and residents of the country receive free healthcare if they have a valid ID.
- Malaysia: All citizens and legal residents must pay a small fee for healthcare services through the public system.
- Maldives: The national health insurance program provides free healthcare for all Maldivians.
- Mauritius: This small island offers free primary care for all residents.
- Morocco: While the country has universal public healthcare, many patients pay copays for services.
- The Netherlands: The Netherlands uses a Bismarck model of mandatory health insurance for all. Patients often have copays and deductibles that they must satisfy.
Learn more: Healthcare in the Netherlands
- New Zealand: In this Beveridge-model system, Kiwis are required to pay copays for primary care physicians and medications. However, hospital care is free. In addition, if you are injured in an accident, your medical care is free whether you are a citizen, a resident or a tourist.
Learn more: New Zealand’s Healthcare System
- Norway: All Norwegian taxpayers are part of the healthcare system, regardless of citizenship. Members of the healthcare system pay up to a maximum limit per year (roughly USD$200), at which point the government covers any other costs incurred.
- The Philippines: All Filipinos are automatically enrolled in the PhilHealth system, which reimburses them for health care costs. Expats can also pay to join the system.
Learn more: Healthcare in the Philippines
- Portugal: The nationally run healthcare system, the SNS, requires copays at the point of service.
Learn more: Healthcare System in Portugal
- Saudi Arabia: While Saudi citizens receive free healthcare, all expats must have private health insurance.
- Serbia: Because it requires participation in the national insurance system, this is a country with free healthcare at the point of service for citizens, permanent residents and even some temporarily residents
- Seychelles: Primary health care is free for all citizens.
- Singapore: Citizens and permanent residents have a mandatory medical savings plan and mandatory health insurance for catastrophic coverage. The government runs many health care facilities and also controls medication costs, which keeps out-of-pocket prices relatively low.
Learn more: Understanding Singapore’s Healthcare System
- Slovenia: The national health insurance system here covers most costs, but residents and citizens have certain copays for care.
- South Korea: All residents must pay into the National Health Insurance System (with a few exceptions). The country automatically enrolls residents after six months in South Korea. Residents also have copays whenever they receive medical care, but the cost to the patient is relatively low.
- Spain: Spain’s Sistema Nacional de Salud (SNS) is a Beveridge system like the UK’s NHS that provides the country with free healthcare. Legal residents can register for the system. Members get free doctors’ visits. Most tests, services and procedures are done at no charge.
Learn more: Healthcare System in Spain
- Sri Lanka: This is a country with free healthcare for all citizens through a government-run health system. However, due to current economic issues, the public health system lacks supplies and resources.
- Sweden: Like Spain, New Zealand and the U.K., Sweden has a Beveridge system with state-run healthcare. But it is not free at the point of service. Most patients must pay a fee at doctors’ visits, at the hospital, and for other care. If patients reach the maximum out-of-pocket cost for the year, they are exempt from copayments for the rest of the year.
Learn more: Sweden’s Healthcare System
- Switzerland: Like Germany, Austria and other Bismarck-system countries, all Swiss residents are required to purchase health insurance. They have a choice of deductible and also have small copays for most services.
Learn more: Understanding Switzerland’s Healthcare System
- Thailand: Three public health insurance programs combine to cover all Thai citizens. For citizens of Thailand, healthcare is free at point of service. Expats must carry private insurance.
- Trinidad and Tobago: Residents of Trinidad and Tobago receive free primary healthcare at government-run healthcare facilities. Specialist treatment and prescription medications may require a fee.
- Turkey: Through a national insurance model, Turkey provides healthcare for all citizens. Expats who have resided in Turkey for at least a year can join the national insurance program by paying a monthly premium.
- United Arab Emirates: Coverage for citizens differs depending on the emirate. Abu Dhabi and Sharjah provide insurance for all citizens. Dubai provides insurance coverage to citizens that are not part of a government health program. Abu Dhabi requires employers to provide health insurance for expat employees and their families; Dubai requires employers to provide insurance for expat employees, but the employees must purchase insurance for their dependents.
Learn more: Understanding Dubai’s Healthcare System
- United Kingdom: The United Kingdom’s National Health Service is famous throughout the world for providing free healthcare to residents and citizens.
Learn more: Healthcare System in the UK
Is Healthcare Ever Free for Foreigners or Visitors?
What does this mean for travelers and expats? Travelers must do ample research on their intended destinations and not make any assumptions. Just because a country offers free health care for its citizens doesn’t mean that travelers have any coverage at all. For instance, the healthcare system in Canada can be tremendously expensive for uninsured travelers and also for Canadian citizens who have returned from an extended time abroad and have yet to reapply for their free provincial health insurance card. On the other hand, a visit to a public hospital in Europe might cost a traveler nothing more than the promise to return the crutches loaned out as part of treatment for a sprained ankle.
Often, public hospitals have a mandate to never refuse emergency care or deny treatment on the basis of ability to pay. However, those same hospitals may have a broad interpretation of what “ability to pay” may mean. They can draw a fine line between what is a true emergency versus simply a very pressing and uncomfortable situation. Travelers should prepare themselves with knowledge and comprehensive insurance, in which case they will get a very pleasant surprise if they do not receive a treatment bill. Otherwise, travelers may have to cross their fingers and hope their credit card is accepted and their credit limit is high enough to pay for their care.
Best Global Medical Plans Based on the Country Where You Will Be Living
Our advice on the best global health insurance for international citizens or expatriates living in specific countries based on the top destination countries of people living abroad.
Related: Visitors Insurance Coverage
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Quality and Affordability
Of note, on this list of the countries with the best healthcare systems and standards in the world, all countries offer free healthcare. The list includes countries such as Israel, Qatar, Singapore, France, and Australia. However, none of the countries on the list offer unlimited healthcare to travelers. Nor are any of those countries on this list the most affordable with regards to out-of-pocket health care costs. For travelers who are willing to accept the pros and cons of paying for health care as they go, they’re better off focusing on countries with very affordable healthcare, not countries with theoretical “free” healthcare.
Free Healthcare in Unexpected Places
Last but not least, travelers can find excellent, affordable health care services in unexpected places all over the world. Public health campaigns may offer free influenza or tetanus vaccines to anyone and everyone who shows up for a community immunization day. International border crossings may have a health care bureau that offers free malaria testing and treatment. University-based student health clinics may also provide free sexual health services to anyone who requests them. You never know when you might stumble across an opportunity to enhance your health at no extra cost!
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Written by Joe Cronin, the Founder and President of International Citizens Insurance. Mr. Cronin is an authority in the areas of global health, life, and travel insurance, with expertise in advising individuals and groups on benefits for today's global workforce . Follow him @Joe_Cronin_Jr