Is Free Healthcare a Possibility for Expats or Travelers?
They say that the best things in life are free – but does that apply to healthcare? For people in some countries, the idea of free healthcare seems too good to be true. However, there are many countries where citizens or residents never see a bill for the healthcare 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.
But 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, they are likely paying for that care in other ways, typically through their tax deductions. 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?
As mentioned, “free” healthcare isn’t actually free. Citizens usually fund healthcare that government agencies provide 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. They 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 often pay far more. While the United Kingdom’s NHS is known for providing free care for its citizens, the estimated cost of a hospital bed for non-residents, as of 2024, ranged from around $1,200 to $3,000 per day, depending on the facility and level of care required. This significant cost is one of the reasons many expats choose to buy international health 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 healthcare without having to pay for services.
- Universal Healthcare means a healthcare system 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 healthcare.
Both of the systems mentioned above include subsidized elements that are funded by citizens’ taxes.
Which Types of Healthcare Systems Give Free or Universal Healthcare?
There are four basic frameworks countries use to deliver healthcare. While the details may be different, most systems fall into one of the categories below – although the United States has elements of all of them.
Out of Pocket
Patients pay money to service providers in order to receive 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, healthcare is generally provided through private facilities, but bills are paid by the government. In some countries that use this system, patients also have 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 healthcare facilities are private. However, 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 healthcare.
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 healthcare. Unlike the National Health Insurance or Bismarck models, most medical facilities are owned and run by the government. The most famous Beveridge healthcare system is the NHS in the UK, which was designed by William Beveridge himself. New Zealand, Cuba, Hong Kong, and Spain are among the many countries that use this system.
Public healthcare does not mean perfect healthcare. In some countries with government-funded healthcare, the majority of citizens purchase supplemental medical insurance to get faster, higher-quality care from private providers.
Source: https://globalresidenceindex.com/hnwi-index/health-index/
Where Can You Find Free Healthcare?
Only one country offers healthcare that is free for everyone – Brazil. The nation’s Constitution defines healthcare as a universal right, and anyone in the country, even short-term visitors, can receive it 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, which is one of the healthiest countries in the world and the first to introduce free healthcare in 1912. However, it also includes the Central African Republic, which has one of the lowest life expectancies in the world and very few healthcare providers.
List of Countries With Universal Healthcare Systems
The countries listed below have universal healthcare, which is 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 it as affordable and accessible as possible for the largest number of people.
Some of these countries also have systems where the government, rather than the patient, covers the costs for certain types of care. In those cases, we have noted which elements of healthcare 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 who are enrolled in the program. Read more about the Healthcare System in Australia.
- Austria: Austria uses a Bismarck-style healthcare system to deliver universal healthcare. Health insurance is mandatory for anyone who will be in the country for more than six months.
- Bahrain: This country previously used the Beveridge model, but is 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, healthcare 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, the Sistema Único de Saúde.
- Brunei: Healthcare is free for citizens and permanent residents.
- Canada: When Americans think of free healthcare, they often think of Canada. Canada uses a National Health Insurance model, and healthcare is run by the individual provinces and territories. All healthcare systems have to cover certain hospital care, lab tests, and doctor visits. But beyond that, each province or territory differs significantly. Read more about the Canadian Healthcare System.
- China: There are three insurance programs that, together, cover over 97% of citizens. Most services require copays. Read more about the 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. Read more about 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 healthcare is provided by the municipality. All permanent residents, whether or not they are citizens, may enroll in the Finnish healthcare system. Read more about the 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. Read more about the 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. Read more about the 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. Almost all Greek visas require proof of health insurance in Greece.
- Hong Kong: This special administrative region of China has a public system in the Beveridge model, as well as a robust private system. Most healthcare 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. However, specialist visits, tests, and prescription medications in Italy require copays from all patients. Read more about the 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. Read more about the Japanese Healthcare System.
- Kuwait: While Kuwait offers free healthcare 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. Read more about 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, resident, or tourist. Read more about 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 healthcare costs. Expats can also pay to join the system. Read more about Healthcare in the Philippines.
- Portugal: The nationally run healthcare system, the SNS, requires copays at the point of service. Read more about the 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 temporary residents.
- Seychelles: Primary healthcare 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 healthcare facilities and also controls medication costs, which keeps out-of-pocket prices relatively low. Read more about 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 doctor visits. Most tests, services, and procedures are done at no charge. Read more about the 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. Read more about 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. Read more about Switzerland’s Healthcare System.
- Thailand: Three public health insurance programs combine to cover all Thai citizens. For citizens of Thailand, healthcare is free at the 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 who 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. Read more about Dubai’s Healthcare System.
- United Kingdom: The United Kingdom’s National Health Service (NHS) is famous throughout the world for providing free healthcare to residents and citizens. Read more about the 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 healthcare 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 based on 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, they 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.
The Best Global Medical Plans Based on the Country Where You Will Be Living
Read our advice on the best global health insurance for international citizens or expats living in specific countries, based on the top destinations for people living abroad.
Read More: Visitors Insurance Coverage provides International Travel Health Insurance for foreigners visiting a foreign country for a specifed period of time, typically ranging from a week to as long as 12 months.
Private Global Health Insurance Plans
If you are considering living abroad, here are the most popular international health insurance providers. Start planning today by requesting a quote for a health insurance plan to cover you worldwide, no matter where you live or where you want to receive care.
Cigna Global Insurance Plan
- The flexibility to tailor a plan to suit your individual needs
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Xplorer Worldwide Medical Plan
- Premium Benefits, Coverage and Service
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IMG Global Medical Plan
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Quality and Affordability
Notably, all the countries on this list of the best healthcare systems in the world provide free healthcare. This includes nations such as Israel, Qatar, Singapore, France, and Australia.
However, none of these countries offer unlimited healthcare to travelers, nor are they the most affordable in terms of out-of-pocket healthcare costs. For travelers who are willing to accept the pros and cons of paying for healthcare as they need it, it’s better to focus on countries with very affordable healthcare, rather than those with theoretical “free” healthcare.
Read More: U.S Health Insurance for Non-Citizens and The U.S. Healthcare System
Free Healthcare in Unexpected Places
Last but not least, travelers can find excellent, affordable healthcare services in unexpected places all over the world. For instance, public health campaigns may offer free influenza or tetanus vaccines to anyone and everyone who shows up for a community immunization day.
Additionally, international border crossings may have a healthcare 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!
Read More
- Top 10 International Health Insurance Companies
- Comprehensive Global Medical Plans
- Guide to Expatriate Health Insurance
- Health Insurance When Working Abroad
Sources: The Commonwealth Fund, the World Health Organization (WHO), the World Bank, and each nation’s healthcare system.
Author / Editor: Joe Cronin, Founder and President of International Citizens Insurance. Mr. Cronin, a former expat, is an authority in the areas of international travel, and global health, life, and travel insurance, with expertise in advising individuals and groups on benefits for today's global workforce. Follow him on LinkedIn or Twitter.