If you are planning to live abroad, the quality and cost of healthcare can matter more than taxes or rent. But "best healthcare system" depends on how you measure it. One of the most respected comparisons is the Commonwealth Fund's Mirror, Mirror 2024 report, which compares ten high-income countries across five areas: access to care, the care process, administrative efficiency, equity and health outcomes. This guide explains its ranking, adds several countries it does not cover, and explains what each system means for someone moving there.

The Commonwealth Fund ranking

In the 2024 edition, the ten countries compared were Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom and the United States. The top three overall were:

  • 1st: Australia
  • 2nd: The Netherlands
  • 3rd: The United Kingdom

The United States ranked last of the ten. The authors stress that the differences between most countries are small, while the United States ranks last by a wide margin despite spending far more per person than any other country. Rankings based on different measures, such as life expectancy or waiting times, can produce different orders, so it is worth looking at the details.

Australia

Australia topped the 2024 ranking thanks to strong results for equity and health outcomes. Its public system, Medicare, covers citizens and permanent residents for public hospital care and subsidises GP visits, while the Pharmaceutical Benefits Scheme keeps medicines affordable. About half of Australians also buy private insurance, encouraged by tax incentives, to reduce waits for elective surgery. Most temporary visa holders are not covered by Medicare and must hold private insurance, although reciprocal agreements cover visitors from some countries, including the UK.

The Netherlands

The Dutch system requires every resident to buy a basic health insurance policy from a private insurer. The package is set by the government, insurers must accept everyone, and premiums cannot vary by health status. GPs act as gatekeepers to specialists, and there is an annual deductible (eigen risico) for most care beyond GP visits. The Commonwealth Fund rated the Netherlands especially highly for access to care.

The United Kingdom

The NHS provides care free at the point of use to residents, funded by taxation. It scored well on equity and on protecting people from high costs, but waiting times for planned treatment have been a serious problem in recent years. Most visa applicants pay the Immigration Health Surcharge, which gives them the same access as UK residents.

Germany

Germany created the world's first national social health insurance in 1883. Today, most people belong to statutory health insurance funded by income-related contributions shared between employers and employees, while higher earners and some self-employed people can choose private insurance. Germany has more hospital beds per person than most OECD countries, and waiting times are generally short, according to OECD Health Statistics.

France

France combines universal public insurance with widely held complementary policies (mutuelles) that cover most remaining costs. Patients can generally choose their doctors, and the system performs well on outcomes. Newcomers can join the public system (PUMa) after three months of stable residence.

Switzerland

Every resident must buy basic health insurance from a private insurer within three months of arrival. Care is excellent and waiting times short, but premiums are high — roughly CHF 350 to CHF 450 per adult per month on average, depending on the canton and deductible, according to the Federal Office of Public Health — and patients pay a deductible and 10% co-payment up to a cap.

Countries outside the Commonwealth Fund comparison

  • Japan: universal insurance with co-payments of generally 30% for working-age adults, standardised national prices and one of the highest life expectancies in the world, according to the World Health Organization.
  • South Korea: a single National Health Insurance Service covers the whole population, with modern hospitals and short waits; foreign residents staying six months or more must enrol.
  • Singapore: achieves excellent outcomes at relatively low public cost by combining subsidies, compulsory medical savings accounts (MediSave) for citizens and permanent residents, and catastrophic insurance. Foreign workers are not covered by MediSave and rely on employer insurance.
  • The Nordic countries: Sweden, Norway, Denmark and Finland run tax-funded regional systems with low patient fees. Quality is high, although waiting times for non-urgent care can be long.

How much does each country spend?

Spending does not guarantee results. According to OECD data, the United States spends roughly 17% of GDP on healthcare, far more than any other member country, while Germany, France and Switzerland spend around 11% to 12% and the UK, Australia and the Netherlands around 10%. Singapore spends much less, around 5% to 6% of GDP. Yet life expectancy in the US is several years lower than in most of these countries, and more Americans report skipping care because of cost. For people moving from the US, this usually means lower out-of-pocket costs abroad; for people moving to the US, it means budgeting carefully for insurance, deductibles and co-payments.

Mental health and dental care

Two areas often catch newcomers out. Dental care is only partly covered by public systems in most countries, including the UK, Australia and the Netherlands, so adults often pay privately or buy extra cover. Mental health services are included in most universal systems, but waiting lists for therapy can be long, and private sessions are common.

What this means if you are moving abroad

  • Check whether you qualify for the public system, and when. Many countries cover only permanent residents, or require a waiting period.
  • Budget for private insurance where required. Temporary visa holders, retirees and digital nomads are often excluded from public cover.
  • Consider language and access. Excellent systems are less useful if you can't find an English-speaking GP; big cities are usually easier.
  • Look at your own needs. For a chronic condition, check whether your medicines are available and subsidised before you move.

No system is perfect, and national averages hide big regional differences. But the evidence is consistent that universal systems in Australia, Western Europe and East Asia deliver good outcomes at far lower cost than the US.