Since the early days of the pandemic, the World Health Organization (WHO) has been multiplying alerts regarding the cost of health care, especially in countries where the healthcare system has weakened. Health expenditure, already on the rise before Covid-19, have increased considerably and become a burden for many countries. In such circumstances, how should expats deal with healthcare, especially those with health insurance?
State health insurance for expatriates
Healthcare has probably never been so expensive as it is today. The 2020 lockdowns around the world led to constantly rising prices. According to the WHO, every country and government have a role to play. Dr Hans Henri P. Kluge, WHO Regional Director for Europe, and Dr Natasha Azzopardi-Muscat, Director of the Division of Country Health Policies and Systems, believe that state intervention is essential "to avoid the mistakes of the past." These doctors, who are also authors of a report on health expenditure in Europe, State that "public authorities will have to invest more public funds in health [...] even if they face increasing budgetary constraints - in order to address the backlog created by the disruption of health services, mitigate the negative health effects of forgone care, unemployment and poverty, and better prepare for the future”.
It looks like this message was heard by Egypt. Last year, Nabila Makram, Minister of State for Immigration and Egyptian Expatriates, introduced optional insurance following a request from Egyptians living abroad and claiming that they are particularly vulnerable due to the health crisis. This insurance will enable them to benefit from extended social coverage. This includes coverage in the case of an accident or death at work. The subscription fee has been set at 300 Egyptian pounds (16.5€) and 100 Egyptian pounds (5.5€) for the annual renewal of the specific insurance against accidents at work.
The Egyptian expat insurance is quite unique. Other countries follow a standard procedure: expatriates no longer depend on their home country's health system as they are no longer residents once they have settled abroad. So they either take out insurance from their host country (this is generally a prerequisite for employees) or subscribe with private health insurance companies that may have partnerships with their country's health system or not. However, governments around the world haven't shown signs of any willingness to develop specific expat health insurance. As a result, Covid-19 has heightened tensions in the global health sector.
Which are the world's most expensive health systems for expats?
In 2021, the United States was still one of the world's most expensive countries for health care. A visit to a general practitioner costs on average $90 (around €78) with health insurance and $230 (around €200) without insurance. In 2020, basic individual insurance costs around $7,500 per year (around €6,500). For basic family coverage, count over $21,000 (around €18,100). And the pandemic has only increased the costs and widened the gap between populations.
You might have heard that Americans have traditionally used private health insurance, which is not a myth. The country only provides coverage for two types of people: those over 65 with severe disabilities (Medicare system) and people in precarious situations (Medicaid). In 2013, Obamacare (Affordable Care Act - ACA) provided the United States with universal medical coverage. The ACA originally applied to expatriates, but this is no longer the case. Following the reform at the end of 2018 at the federal level, the obligation to take out insurance supervised by the ACA and penalties incurred no longer exist. However, some states have restored this requirement (California, Vermont, Massachusetts and New Jersey). Hence the importance of checking which health coverage is available in the State you are relocating to.
Switzerland seems to be the second most expensive country regarding healthcare. A hospital stay (outpatient) without affiliation to LAMal, the Swiss health insurance, costs 500-1000 Swiss francs (around 472-944€). A consultation with a general practitioner costs 100 to 200 Swiss francs (around 94-198€). By subscribing to LAMal, however, expats are eligible for coverage, particularly in medical consultations and prescription drugs, hospital and maternity costs. The cost of LAMal depends on the place of residence and the number of dependent children. It is based on a series of deductibles ranging from 500 (€472) to more than 2,500 Swiss francs (€2,360). It's worth noting that cross-border workers can also benefit from attractive rates.
The pandemic has revealed very high healthcare costs in Quebec as well. For example, count 322 Canadian dollars (around 224€) for a simple GP consultation or a visit to the emergency service and 1,078$ (around 752€) for a low-risk surgery. For a 14-day stay in intensive care (Covid-19) count around $53,000, or more than €37,000. Fees are just as high in the rest of Canada, where a simple medical consultation can cost up to $100 (around €70).
The situation isn't any better in Asia, especially in Japan, where healthcare costs have constantly been rising. The ageing population and the historically low fertility rate - 1.36 children per woman in 2021, definitely account for this. Currently, the Japanese health insurance (Kokumin Kenko Hoken for the general public, Shakai Kenko Hoken for employees) covers 70% of the costs; the remaining 30% are the patient's responsibility. Health coverage in Japan is based on annual income. A visit to a general practitioner costs approximately 5,000 yen (€37.84), 30,000 yen for a specialist (approximately €227). Consider additional costs in case further medical examinations are needed. Besides, an emergency visit at night can be quite expensive, considering that rates vary from one hospital to another. This additional cost is generally not covered by health insurance.
Will the significant rise in health expenditure encourage countries to adopt the same approach as Egypt? More and more expatriates are turning to their home country for healthcare, especially since Covid-19. Others choose affiliation to health insurance in their host country and/or contribution to a private organization. In any case, health and especially access to care remain one of the major challenges of our societies, whether in the pandemic or the post-pandemic era.
