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A Healthy Comparison: Healthcare Charges for Workers Around the World

15th August 2017

With a whole new life to build when relocating abroad for work, planning for what you may have to do in the event of an illness or injury is unlikely to be a priority. Of course, you’ll get around to registering with the local doctor, dentist, pharmacist etc, and commit the location of the nearest hospital and emergency number to memory, but faced with a medical emergency do you know whether you’ll even be seen in your new country of residence before you can prove you’ve got the means to settle the bill?

We’re spoilt living in the UK with the National Health Service on hand to patch us up whatever the health emergency or niggle. If you’ve got a nagging doubt you can call your GP and arrange an appointment to discuss your concerns (we’re not here to ponder waiting times but the point is this service is free at the point of use). If you have a fall, a road traffic accident, a serious health episode like a heart attack or stroke or a long-term or terminal condition, ultimately you know the NHS will be there to fix you up as well as possible, no questions asked.

On-call care

Our always-on health service can leave less clued-up Brits locating abroad with a false sense of security or entitlement. The NHS has always picked up the pieces and it will do again, surely? Oh, it’s not accessible here, well what’s the system? To some extent you may be on the right track if you’re travelling to the right country with your NHS safety blanket firmly intact but most countries operate on a national health insurance basis for permanent residents.

If you’re visiting a country in the European Economic Area (EEA) or Switzerland perhaps on holiday or on a business trip, the free-of-charge European Health Insurance Card (EHIC) entitles you to medically necessary treatment at a reduced cost or sometimes for free and the NHS will be billed accordingly. The card also covers the treatment of pre-existing medical conditions and routine maternity care, plus oxygen and kidney dialysis but it isn’t an alternative to health insurance and isn’t a permanent solution.

If you’re moving to an EEA country or Switzerland permanently to live, work or study, the rules are different and you will no longer be automatically entitled to medical treatment under normal NHS rules. The NHS is based on residence in the United Kingdom so when you emigrate you need to notify your GP to be removed from the NHS register and make sure you have the necessary provisions in place in your new home.

Health service versus insurance

There are, however some exceptions. People with an exportable UK State Pension or UK benefits can receive state healthcare paid for by the UK, as can workers who are posted to a EEA country or Switzerland. An au pair or nanny working will get an extended 12-month EHIC after which time they must obtain healthcare cover in their country of employment. And members of the British Armed Forces and their dependents are entitled to a UK-issued EHIC regardless of the EEC country to which they are posted.

No matter where you’re going you should get in the mindset of budgeting for any additional healthcare costs including health insurance. Check which health services are available in your destination country as it might not include some offered free of charge under the NHS. You will need to register with the relevant authorities abroad and once you are working and making national insurance contributions you will be entitled to the standard state-run healthcare on the same basis as any other resident. Many countries will expect you to make patient contributions or join its national health insurance scheme just as the NHS back home expects co-payment for prescriptions, glasses, dental care and wigs.

Global healthcare

If you are visiting a country outside the European Economic Area (EEA) you will not be covered for healthcare paid by the UK unless it’s one of the countries or territories with whom we have a reciprocal agreement: Anguilla, Australia, Bosnia and Herzegovina, British Virgin Islands, Falkland Islands, Gibraltar, Isle of Man, Jersey, Macedonia, Montenegro, Montserrat, New Zealand, St Helena, Serbia and the Turks and Caicos Islands. If you’re visiting any of these places and need urgent or immediate medical treatment you will receive the same help you would as a local resident. The range of medical services may be more restricted than under the NHS and will not cover the cost of returning you to the UK or the route monitoring of pre-existing conditions.

If you’re making a permanent move to a non-EEA country, you won’t be entitled to UK-funded medical treatment. You will be entitled to receive the healthcare of your new home country once you are living and contributing as a resident.

Non-national NHS

So how does this all compare to the experiences of people who up sticks for the United Kingdom? The NHS now generally requests payment before giving treatment to non-nationals without the appropriate cover or certification so it pays to be prepared before you travel.

The NHS is a residence-based system rather than most countries’ insurance-based healthcare systems so if you can’t prove residence you will have to have the right documentation. Visitors from the EEA and Switzerland who fall ill or have a medical emergency while in the UK need to hold a valid EHIC issued by their home country (who will be billed by the NHS) or they may have to pay for treatment. The EHIC covers all medical treatment that becomes necessary while here on their stay. As with Brits abroad it may not cover all they might receive back home.

Crackdown on health tourism

Non-EAA visitors on a temporary visit to England – even former residents – should ensure their personal medical or travel insurance covers them for their stay. If they need NHS treatment and do not have insurance they may be charged at 150% of the standard NHS rate unless an exemption category applies to them or to the treatment required. This charge was enforced as a crackdown on ‘health tourism’ in a bid to save the NHS £500 million a year but visitors will not be denied urgent emergency treatment before seeking payment or proof of residency.

Treatments and services exempt from NHS charges include accident and emergency, family planning, treatment for most infectious diseases and treatment for a physical or mental condition caused by torture, domestic or sexual violence.

Residents of a country with a reciprocal healthcare agreement with the UK may be covered for some treatments as well as vulnerable patients, detainees, workers on UK registered ships and NATO personnel. People who move to the UK but who do not contribute to the NHS through their taxes should expect to be billed for 100% of their treatment plus an extra 25% to raise money for NHS funds.

As we have seen, there is no catch-all rule for people who need medical treatment regardless of where they are living or relocating to. Register for local services, make sure you’re up to date on your health and travel insurance policies, learn the local guidelines and make sure you ‘belong’ somewhere. As a relocated worker, these and many other factors need to be considered in advance of an illness or injury to make sure the bill you get presented with isn’t an even bigger shock to the system.