Healthcare for expats in the OECD and beyond

An overview of the healthcare systems in Organization for Economic Co-operation and Development countries (OECD) and elsewhere.

While money, career improvement and a change of lifestyle are important factors for expats, health provision can also play a crucial role when choosing a destination. More so if the expat has specific healthcare needs and is considering moving to a country that has a starkly different health system and culture compared to their home nation.

This uncertainty could lead to expats playing it safe and opting for countries in the OECD (Organization for Economic Co-operation and Development) such as Spain or Canada. But such a decision would leave out countries which may still be very attractive – Singapore and India for instance – but which may not fit the OECD’s profile.

This article draws comparisons between two OECD countries – Spain, Canada, and two non-OECD countries Singapore and India.

Making a more informed choice

By comparing OECD nations to others, expats may gain a better understanding of the quality of healthcare on offer and then be more inclined to look beyond OECD nations.

It can be difficult to compare national health systems side by side because many operate differently and offer a varying range of services.

The UK’s health system and spending, for example, includes social care, a service which might not be offered as part of the health system in other countries.

A balanced view

To form a sound comparison, it is therefore beneficial to find a balance between quality of service and GDP spend. Spend indicates that improved healthcare is a priority of the government whereas quality can offer reassurance to potential expats that they will receive the type of care they need.

Of the nations that spend the most on healthcare, 8 out of 10 are European and all are members of the OECD. By comparing four popular expat destinations – from within and without Europe and the OECD – expats may gain a clearer understanding of which country offers them the most appropriate type and level of healthcare.

Spain – Member of OECD since 1960 (founding member)

The Spanish universal healthcare system is highly regarded worldwide. The World Health Organization’s DALE (disability-adjusted life expectancy) health level scale placed Spain’s healthcare at number seven out of 191 countries.

In comparison to the total healthcare spending of OECD nations, Spain is spending just over the 9% of GDP average, with some 16 other nations spending more. In recent years however, austerity has reduced the level of healthcare expenditure.

Between this and the decentralization of care, the level of healthcare may vary between the country’s 17 regions. However, the 2016 Expat Explorer Survey revealed that, in terms of lifestyle, expats from Spain ranked their overall health very highly, ranking number one in the world. While the climate and lifestyle might have had an influence on this result, it is also a strong indicator of the quality of – and satisfaction with – the health service available to expats in Spain.

Canada – Member of OECD since 1960 (founding member)

In 2014, Canada’s healthcare system cost was 10.95% of GDP. This is higher than the OECD average, but in terms of efficiency – the balance between quality of care and cost – Canada’s healthcare system is the third most effective in the Americas.

The Legatum Institute’s Prosperity Index also ranks Canada 16 out of 149 countries for its healthcare. This may not be a top ten ranking for such an advanced country, but it still ranks much higher than its neighbor, the US (32), although it only just beats Spain in 17th.

This index isn’t an assessment of the entire health system either. Instead, it is a measure of a country’s performance in three key areas: physical and mental health, health infrastructure and preventative care – areas which are of importance to expats and their families. The higher the ranking, the better.

Canada’s healthcare system, known as Medicare, sees the delivery of healthcare taking place on a regional level by not-for-profit trusts and municipalities, with policies and programs determined by government.

Every permanent resident requires a Health Card to access public health insurance, but it is normal for expats to wait three months from the date residence was established before receiving their card. While all Canadian territories will provide free emergency services without a health card, it is still important that expats arrange international health insurance for this period.

India – Non-OECD member

India may not be an official member of the OECD but it has had enhanced engagement since 1995, while a 2007 OECD resolution strengthened that co-operation.

With one of the largest populations in the world, a 2015 United Nations study predicted that India’s growth will see it overtake China in 2022 and become the world’s most populous country, peaking at over 1.6 billion people by 2060.

Providing healthcare for such a large number of people and in one of the largest countries in the world is a challenge for the government. To deal with this, health spending has increased every year from 2010 (4.2%) to 2014, where it reached 4.68% of GDP.

The majority of India’s healthcare is handled by private hospitals, resulting in a high cost of care. As such, expats will need to plan properly for their healthcare if considering India as a destination. Technological innovations are also being introduced which may even reduce the need for a hospital visit and keep costs in check.

Despite this challenge, expats in India ranked the quality of healthcare in the country at 27th out of 45 popular expat destination countries. While this position might seem reasonable and perhaps unremarkable, expats have in fact ranked India 18 positions above the United States and one position behind Japan: countries which have incredibly advanced healthcare systems.

Singapore – Operates outside the OECD

As other nations’ healthcare costs have been markedly affected by challenges like austerity or a booming population, Singapore has quietly and continued to improve. The result is a very highly-rated healthcare system which ranks second for health in the Legatum Institute’s 2016 Prosperity Index.

Remarkably, the quality of care has been reached with a low spend. Bloomberg’s 2014 healthcare efficiency rankings saw Singapore’s system ranked as the best in the world, spending just 4.5% of GDP on healthcare costs, a factor that is even more remarkable considering that the OECD average, as of 2014, was 9%.

Singapore offers a balance between public and private healthcare with 10 public hospitals that offer both walk-in and emergency care. There are also 13 private hospitals and a number of clinics for specialist treatments.

Compared to other parts of Southeast Asia, costs can be high, but with English widely spoken and a combination of private health insurance and the mandatory Medisave programme, Singapore could offer expats a high level of care for reasonable cost.

High-quality healthcare beyond the OECD is possible

As demonstrated by the efficiency of Spain and Canada’s healthcare systems, high quality care that ranks in the top 20 worldwide can be achieved with a GDP spend close to or just above the OECD average of 9%. While this could prove comforting for expats looking to work in an OECD nation, there is also encouragement for those who are considering moving to nations in Africa and Asia.

While India’s ranking of 27th out of 45 popular expat destinations is unremarkable, the steady increase in health expenditure since 2010 means that the 2014 figure of 4.6% is higher than at any point since 2001. As the fluctuation of the previous decade has become a steady increase, India could likely see a rise in the reputation of its healthcare system in the coming years as this investment matures.

While the OECD nations sampled prove the high-quality of care member nations can offer, Singapore demonstrates that many expats can find affordable, high-quality healthcare beyond those 35 nations. It delivers world-class healthcare with a health spend that is not only half of the OECD average but, at 4.5% of GDP, even less than India.

In other words, when reviewing the healthcare a country has to offer, it may be wiser for the expat to think beyond official memberships and consider wider factors. In that way, they may gain a wider appreciation of the current and future status of a country’s health service and decide whether it will meet their needs.

Of course, for expats unfamiliar with the OECD, there are also less formal ways of judging how effective a country’s health care may be. The HSBC Expat Explorer Survey for instance allows expats to assess countries across several dimensions; not just health.