Ask a family weighing a move to Dubai or Lisbon what relocating will cost, and the conversation usually opens with tax rates and investment thresholds. Health insurance comes up later, often as an afterthought. Yet it recurs every year, and it is now climbing much faster than inflation.
A health cost index published on October 1 by Swiss health advisory firm SIP Medical Family Office puts numbers on that climb. Across the 50 countries covered in both this year’s and last year’s editions, the price of top-tier international private medical insurance (IPMI) rose by an average of 18%.
Ranked by what such cover costs a resident, the index puts several favorite destinations of wealthy movers near the top of its 60 countries. Some of the world’s wealthiest countries, meanwhile, sit near the bottom.
What the Index Measures
Rather than surveying hospital bills, the index prices insurance. Its authors gathered quotes for three fixed profiles in each country: a 35-year-old British man, a 50-year-old American woman, and a 24-year-old Indian woman.
Seven international insurers, including Cigna Global and AXA Global Healthcare, quoted each profile on their most generous plan with no deductible.
A country’s score averages all those quotes, including insurance premium tax. Because the profiles keep the same ages from one edition to the next, any change in price comes from insurers repricing, not from customers getting older.
According to Kevin Bürchler, the firm’s chief executive, the 18% headline is “the average of each country’s percentage increase.” That makes it an unweighted figure, in which a small market’s swing counts as much as the US’s 33% jump or Japan’s 3% rise.
Premiums are an imperfect proxy for medical prices. They also carry insurers’ administrative costs and their claims experience with expatriate customers, and the authors caution against reading the changes as pure medical inflation. The rise “does not mean individual treatments have become 18% more expensive,” the report notes, pointing instead to aging populations, longer lives, heavier use of care, and demand for preventive and longevity medicine.
The figures also describe the top of the market. Plans with a deductible or regional cover cost less, so the index works better as a comparison between countries than as a price list. Its publisher also advises clients on IPMI and has group companies licensed as insurance intermediaries in the EU and the UK, so it has a commercial stake in the product it measures.
Where Wealth Goes, Premiums Follow
The five priciest markets have not changed since last year. Top-tier cover for a US resident now averages $23,987 a year, ahead of Hong Kong ($19,353), Singapore ($17,613), China ($15,235), and the UK ($14,987).
Dubai, which stands in for the UAE in the index, climbed from 10th to sixth after a 25% increase, and cover there now averages $12,142. Saudi Arabia’s 33% rise matched the US for the steepest in the index.
Several of these markets are also, as the report puts it, leading destinations for internationally mobile high-net-worth individuals. Hong Kong, Singapore, and the UAE all sit in the top six, while Switzerland (12th) and Monaco (23rd) posted increases of 21% and 26%, respectively.
In Bürchler’s reading, inflows of affluent individuals and entrepreneurs “stimulate demand and investment in premium healthcare infrastructure, quality and services,” while “potentially contributing to higher prices.” The report’s authors stop short of calling the link causal.
Regulation appears to matter too. Japan’s premiums rose just 3%, the smallest increase in the index, and Greece’s rose 6%, even though the Greece Golden Visa remains one of Europe’s most popular. Slower growth tends to accompany tighter oversight of what providers can charge, according to the report, which contrasts those markets with the US, where providers set their own prices and premiums climbed by a third.
Rich Countries, Cheap Premiums
Norway, the Netherlands, and Sweden are among the world’s wealthiest countries, yet all three rank among the 10 cheapest markets to insure. Mexico (seventh), Brazil (eighth), and Thailand (10th), meanwhile, all cost more than Switzerland.
According to World Bank figures cited in the report, Norway spends about $8,300 per person on healthcare, roughly 25 times as much as Thailand. Top-tier private cover for a Norwegian resident still costs about a third less.
Private insurance is a supplement in Norway and the Netherlands, not the main route to care. The Norwegian public system already shields residents from catastrophic hospital bills, according to the report, while Dutch rules mean even private patients usually need a family doctor’s referral to see a specialist.
Thailand and Brazil work the other way. Routine care there is affordable, but expatriates rely on private hospitals, and the report warns that inpatient care at an internationally renowned Thai hospital “can quickly become as expensive as in some of the most expensive countries.” A retiree drawn to Bangkok by low living costs should budget for insurance at roughly Swiss prices.
The Tax Inside the Premium
In parts of Europe, a slice of every premium never reaches a doctor. The report lists nine European markets where insurers must add insurance premium tax, led by Greece at 15%, France at 14%, and the UK at 12%, and the index folds that tax into each country’s figure.
That choice moves the rankings. By IMI’s calculation, stripping the tax out of all nine markets would drop Greece from 16th to roughly 33rd, with an underlying premium of about $8,934 rather than $10,274. France would fall from 36th to around 52nd.
Removing the tax “would indeed change the ranking,” Bürchler acknowledged, but the index keeps it in because “consumers ultimately pay for this when accessing care through private insurance.”
For a family budgeting a move to Athens, the taxed figure is the real bill. Anyone judging whether Greek healthcare itself is expensive should look at the pre-tax number, which places Greece near Italy and Portugal rather than just above Australia.
A Passport Does Not Set the Premium
Three of the Caribbean’s five citizenship by investment (CBI) states appear in the index for the first time, and they are nearly impossible to tell apart. Antigua & Barbuda ranks 27th at $9,380, St. Kitts & Nevis 28th at $9,352, and Grenada 30th at $9,293.
Two of them, Antigua and Grenada, show identical premiums for two of the three profiles. Some insurers place Caribbean countries in a single pricing zone while others price them individually “with minor differences,” according to Bürchler, who added that private healthcare costs and patterns of use are much alike across the islands. “The difference is so small that I would say it is not meaningful.”
For CBI investors, the more useful point is that premiums follow residence, not citizenship. Many investors never live on the islands at all, and a Grenadian citizen based in Dubai is priced as a Dubai resident, though one insurer in the index notes that nationality can also affect its pricing.
Those who do move should treat the Caribbean figures as a floor. The quotes exclude US coverage, yet the report notes that islanders needing complex care often travel to the US, and that including such access would raise costs substantially.
Older Movers Pay the Most
Age widens the gaps further. Across most markets, the 50-year-old American woman pays about 1.4 times what the 35-year-old British man does, and in the US her premium reaches $34,391 a year. Because the profiles also differ in sex and nationality, the gap is not purely about age, but its direction is clear.
Dubai is an outlier. Its 35-year-old profile ranks only 13th, below Greece, yet both female profiles rank sixth, and the 50-year-old pays 1.8 times what the man does. The report points to the emirate’s tiered hospital networks and to rules under which insurers may load premiums for pre-existing conditions but may not exclude them.
None of the profiles is older than 50, which leaves retirees without a benchmark. For them, the bigger hurdle may be getting covered at all: private medical insurance involves a medical declaration at application, and the report warns of exclusions “or even full rejection” over pre-existing conditions.
The report’s case for international cover rests on portability. Domestic private policies usually depend on residence status and lapse when the holder moves abroad, while an IPMI policy moves with him.
Dubai requires that residents hold health insurance, though the report notes that foreigners widely regard the mandatory basic plan as insufficient; most international plans build it in so that they count for visa purposes. Thailand’s Long-Term Resident (LTR) visa requires that applicants hold a policy covering at least $50,000. Meeting a visa’s minimum and buying cover a family would actually rely on are separate exercises.
Pricing Healthcare Into a Move
Bürchler says healthcare quality and the cost of private care are becoming “an increasingly important factor” when families decide where to move. If healthcare is on your own relocation checklist, here is how to price it properly.
- Get your own quote. The index’s three profiles are a yardstick, not a price list. A 62-year-old couple moving to Lisbon will pay something quite different, so ask for quotes based on your real ages and the country you’ll actually live in before you commit to a program.
- Expect the bill to grow. Premiums rose 18% on average in a single year, and by a third in the US and Saudi Arabia. Budget for that rather than assuming this year’s price will hold.
- Decide early whether you need the US. None of the quotes cover treatment there for non-US residents. If you’d want to fly to the US for serious care, as many Caribbean islanders do, expect to pay considerably more.
- Don’t confuse the visa minimum with real cover. The policy that gets you past an immigration officer can be much thinner than the one you’d want in a hospital bed.
- Think about a deductible. Every quote in the index assumes you pay nothing out of pocket. Some residents in Greece insure only against major medical events, and some in Mexico pay for routine visits themselves and keep insurance for hospital stays.
- Buy while you’re healthy. Insurers check your medical history when you apply, so good cover is far easier to get before a diagnosis than after one.
