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The Countries With the Best Public Health Care Systems in Your Retirement

By Rebecca Moody May 12, 2021 Aging

If you’re looking to retire to another country, some important factors will be days of sunshine, quality of life, cost of living, distance from relatives, and access to amenities. But one of the most critical considerations that could make or break your new life in the sun will be the standard and cost of healthcare in the country of your choice.

Which country boasts top-quality healthcare systems that are cost-effective (and even free) for residents?

We assessed 189 countries across 9 categories to see where the most efficient and cost-effective system might be for you. From life expectancy and health expenditure per capita to the number of hospital beds and physicians per 1,000 people, we’ve found the top 10 best countries for affordable, efficient, high-quality healthcare.

What did we find?

9 out of the top 10 countries are in Europe, suggesting the healthcare systems in place here offer the best all-around benefits for residents. But for those looking for something “across the pond,” there’s Cuba.

The Top 10 Countries for Healthcare Systems

According to our study, the following countries stand out as having the best overall healthcare systems in the world:

1. Iceland – With perfect scores for its healthcare access and quality index as well as its universal healthcare, Iceland takes our top spot. It also boasts one of the highest life expectancies (83 years) – just one year off top-scorers Switzerland and Japan. In fact, the only category it doesn’t score highly in is the number of hospital beds. With just 2.8 per 1,000 people, it falls significantly short of the top-scorer, Japan, which has 13 beds per 1,000 people. Nevertheless, it does enjoy a high number of midwives and nurses (16.2 per 1,000).

2. Norway – Norway enjoys the same high scores as Iceland for its life expectancy (83 years), top-notch healthcare access and quality, and universal health care. It also beats Iceland for health expenditure per capita ($8,239.10 compared to $6,530.93), overall public expenditure (85.32% compared to 82.37%), hospital beds per 1,000 people (3.5 compared to 2.8), and nurses and midwives per 1,000 people (18.2 compared to 16.2). However, it drops to second place because of its lower scores for the number of physicians per 1,000 people (2.9) and specialist surgical workforce (67 per 100,000). These are also the worst scores out of top 10 countries.

3. Sweden – Like Iceland and Norway, Sweden boasts universal health care, scoring full marks in this category. It’s also the best of our top 10 for surgical expertise with 113 specialist surgeons per 100,000 people, but this does still fall quite short of top-scoring Greece which has 164 per 100,000. Sweden was also the lowest scorer in the top 10 for the number of hospital beds with 2.1 beds per 1,000 people. Of our top 10, it also had the second-lowest number of nurses and midwives per 1,000 (11.8).

4. Germany – With 8 hospital beds per 1,000 people, Germany scores significantly higher than all of our top 10 for hospital beds (they have an average of 4.11). That said, it is still fourth-place overall, with Japan, South Korea, and Belarus having 13, 12.4, and 10.8 beds per 1,000 people respectively. This vast “oversupply” of hospital beds meant Germany was much more prepared for the COVID-19 pandemic than its European neighbors, having faced criticism for having too many in previous years. Something to consider with Germany, though, would be its compulsory use of private health insurance as a health care system rather than a government-funded system like the majority of our top ten.

5. Finland – With the second-best healthcare access and quality score and full points for its universal healthcare, Finland comes in at fifth place. Like the majority of our top 10, it has above-average scores for its life expectancy (82), the percentage of healthcare funds that come from public expenditure (78.6%) and the number of nurses and midwives per 1,000 people (14.7). Elsewhere, it has average scores and falls short when it comes to the number of hospital beds per 1,000 people (3.6).

6. Ireland – Like Finland, Ireland scores well with average scores across the board alongside above-average scores for healthcare access and quality and full points for its universal healthcare. It too falls short when it comes to hospital beds (3 per 1,000 people).

7. Cuba – Cuba is the first and only country in our top ten to be located outside of Europe. Despite having an incredibly low score for its healthcare expenditure per capita ($986.94), the lowest life expectancy and number of nurses and midwives per 1,000 in our top 10 (79 and 7.6 respectively), and the lowest healthcare access and quality score (76), it does stand out in other areas. Not only does it get full points for its universal healthcare (like most of our top 10), it is also the top-scorer overall for the percentage of public funds used on healthcare expenditure (88.91%) and for the number of physicians it has per 1,000 people (8.4). The latter is likely due to cheap education, with many doctors practicing medicine in Cuba before moving elsewhere when they are qualified.

8. Switzerland – As the best country for life expectancy (joint with Japan at 84 years), Switzerland takes the eighth position. It’s our best-scorer in the top ten for health expenditure per capita ($9,870.66, second only to the US with $10,623.85). Elsewhere, it has similar scores to the majority of our top 10 but does fall significantly short when it comes to how much expenditure on healthcare comes from public funds (just 31.10%). Needless to say, this is why it’s also one of the three top-10 countries that doesn’t have fully government-funded healthcare, instead using a universal private health insurance system.

9. Belgium – Like Switzerland, Belgium’s healthcare system isn’t funded solely by the government, but it does employ a universal public insurance system rather than a private one. Belgium also has the highest number of nurses and midwives in our study with 19.5 per 1,000 people. In all of the other categories, it scores reasonably well and only lacks where most of the other top 10 countries do (hospital beds and physicians per 1,000 people – 5.6 and 3.1 respectively).

10. Denmark – Just making it into the top 10 is Denmark, which gives us a 3 out of 3 for Scandinavian countries in the top 10. And like all of the other top-scoring countries, it enjoys reasonable or above-average scores in most categories. It did, however, come second from the bottom in the top ten for hospital beds with only 2.6 per 1,000 people.

As you can see then, while the top 10 do often boast great healthcare expenditure funds (often publicly-funded) and good access to quality healthcare, many of them are lacking when it comes to hospital bed access and the number of physicians per 1,000 people. The number of specialist surgeons per 1,000 are also just above average for most.

So, with no country standing out across the board, which countries come out on top for each category?

The Top Performers in Each Category

Whether you like the idea of not having to dip into your pension pot by accessing free healthcare or want the reassurance of having specialist surgeons on hand, find out which country comes out on top in each of our essential healthcare categories below.

Best for Life Expectancy – Switzerland and Japan

With a life expectancy of 84 years, those in Switzerland and Japan live over 10 years longer than the average global person who lives for 72.6 years. As Switzerland came 8th and Japan 11th, both offer a great healthcare service, which is reflected in the longevity of their life expectancies.

Best for Health Expenditure per Capita – United States

The United States has the highest health expenditure per capita with a massive $10,623.85 – over $9,500 more than the average of all the countries we studied ($1,190.11). However, with only 50% of these funds coming from public expenditure and its non-universal insurance system, this won’t be the place for those looking to be savvy with their pensions.

Best for Overall Public Health Expenditure per Capita – Cuba

On average, public sources account for nearly 52% of healthcare expenditure. But in Cuba, a whopping 88.91% comes from public funds. As we’ve seen, this is reflected in its low expenditure per capita ($986.96).

Best for Hospital Beds – Japan

Not only does Japan have the joint-highest life expectancy but it’s also our top-scorer for the number of hospital beds per 1,000 people (13). This is also significantly higher than the average of 2.88 beds per 1,000. However, despite this, it doesn’t make it into our top 10 and this is primarily due to its low scores for the number of physicians per 1,000 people (2.4) and the number of specialist surgeons per 100,000 people (37). So while there may be enough beds, getting access to the right professional may be more difficult.

Best for Physicians – Cuba

In sharp contrast to Japan, Cuba has the highest number of physicians per 1,000 people (8.4). This is over four times than the average of 1.92. Georgia followed closely in second place with 7.1 physicians per 1,000 people.

Best for Nurses and Midwives – Belgium

The average country has 4.62 nurses and midwives per 1,000 people but Belgium has far, far more than this with 19.5. Norway and Switzerland also boast a high number with 18.2 and 17.5 nurses and midwives per 1,000 people respectively.

Best for Specialist Surgical Workforce – Greece

Leading the way for specialist surgical workforces is Greece with 164 per 100,000 people. This is over 127 percent more than average (36.42) and 22 more than second-place Italy (142).

Best for Healthcare Access and Quality Index – Iceland and Norway

It’s perhaps no surprise that the countries at the top of our list – Iceland and Norway – are the ones who score almost perfect scores (97/100) in the Healthcare Access and Quality Index. The index monitors 32 causes of death that shouldn’t occur with effective healthcare, highlighting the exceptional services on offer in these two countries.

To What Extent Does Each Country Have Universal Health Care?

To see where healthcare may feel more cost-effective, we created a three-part scoring system that focused on access to universal healthcare and how it is funded.

1. Universal Government-Funded Healthcare – 31 countries in our study were found to have government-funded universal healthcare and, therefore, received maximum points. Here, residents have peace of mind that most of them (or all) will be entitled to most of the health care free of charge.

2. Universal Public or Private Insurance – 62 countries have universal healthcare that isn’t funded solely by the government, which results in a middle-of-the-road score (50). Instead, they use a public or private insurance system which then provides residents access to some or completely free healthcare. These insurance systems may be mandatory or voluntary.

3. No Universal Health care – 68 countries received zero points due to their having no universal healthcare at all. The US stands out as one of the most highly-developed and largest countries on the list to not provide universal healthcare to its residents. Others tend to be less developed countries that are currently working with WHO to achieve universal healthcare in the next 10 years.

Find a Country with Great Healthcare and a Stress-Free Lifestyle

In one of our previous studies, we looked at some of the best countries in the world for enjoying a stress-free retirement. Top of the list was Finland. Sweden also made the top ten in this study, too, as did Austria and Japan (which also score well in this study). This makes these four countries some of the most standout when it comes to choosing a healthy and happy place to retire to.

Methodology

Our research began with 189 countries before being reduced to 161 who had a full set of data for us to compare. We then selected 9 categories that analyzed the differences in healthcare systems around the world. These were:

Life Expectancy – Life expectancy at birth indicates the number of years a newborn infant would live if prevailing patterns of mortality at the time of its birth were to stay the same throughout its life.
Health Expenditure per Capita – Current expenditures on health per capita in current US dollars. Estimates of current health expenditures include healthcare goods and services consumed during each year.
Percentage of Health Expenditure from Public Funds – We used the total amount of healthcare expenditure to come from public funds and compared to the overall health expenditure per capita to create a percentage.
Hospital Beds (per 1,000 people) – Hospital beds include inpatient beds available in public, private, general, and specialized hospitals and rehabilitation centers. In most cases, beds for both acute and chronic care are included.
Physicians (per 1,000 people) – Physicians include generalists and specialist medical practitioners.
Nurses and Midwives (per 1,000 people) – Nurses and midwives include professional nurses, professional midwives, auxiliary nurses, auxiliary midwives, enrolled nurses, enrolled midwives, and other associated personnel, such as dental nurses and primary care nurses.
Specialist Surgical Workforce (per 100,000 population) – The specialist surgical workforce is the number of specialist surgical, anesthetic, and obstetric (SAO) providers who are working in each country per 100,000 population.
Healthcare Access and Quality Index – 32 causes from which deaths should not occur were selected in the presence of effective care and approximate personal health-care access and quality by location over time. Scored from 0-100.
Universal Health Coverage – Each country was researched individually to find out what type of healthcare system it had. Three categories were then generated: Universal and government-funded healthcare (100 points), universal healthcare but not fully government-funded, often with insurance, co-payments, or out-of-pocket payments (50 points), or no universal healthcare (0 points). The latter category has some countries that have not achieved universal health care but do have some free healthcare for residents, we choose to score them as 0 to make universality the key importance in our study. This meant that countries like Jamaica which offer free healthcare to citizens still scored 0 because they have not achieved universal healthcare yet. Similarly, the US scored 0 for not having universal healthcare.

Our scoring system ranked the countries from 0-100 for each category, the highest scores got 100 points and the lowest scores getting zero points. All of the countries in between these two scores received a score on a percentile basis, depending on where they ranked.

A total score was achieved by averaging each country’s score across the 9 categories.

Sources –

https://data.worldbank.org/indicator/SP.DYN.LE00.IN

https://data.worldbank.org/indicator/SH.XPD.CHEX.PC.CD

https://data.worldbank.org/indicator/SH.XPD.PVTD.PC.CD

https://data.worldbank.org/indicator/SH.XPD.GHED.PC.CD

https://data.worldbank.org/indicator/SH.XPD.OOPC.PC.CD

https://data.worldbank.org/indicator/SH.MED.CMHW.P3

https://data.worldbank.org/indicator/SH.MED.BEDS.ZS

https://data.worldbank.org/indicator/SH.MED.PHYS.ZS

https://data.worldbank.org/indicator/SH.MED.NUMW.P3

https://data.worldbank.org/indicator/SH.MED.SAOP.P5