Overview
Around 70 countries operate some form of universal healthcare, funded either through general taxation (the UK, Ireland, Spain, Portugal, Italy, Canada, Australia, Brazil) or through mandatory social insurance (France, Germany, the Netherlands, Japan, South Korea). In both models the care is free or near-free at the point of use for people who are inside the system — and chargeable for people who are not.
The distinction that matters is not "is healthcare free here?" but "am I eligible here, today?" That answer changes with your residency status, your nationality, how long you have been in the country, and whether you carry an EHIC or GHIC.
What "Free Healthcare" Actually Means
Even inside the most generous systems, four things are normally charged for:
- Primary care visits — free in the UK and Spain, €50–€70 in Ireland without a medical card, reimbursed-after-payment in France.
- Prescriptions — £9.90 per item in England, capped at €80 a month in Ireland, small co-payments across most of Europe.
- Dental and optical care — largely excluded from "free" systems everywhere, including Canada and Australia.
- Waiting time — the real cost. Non-urgent specialist and elective waits run months in most tax-funded systems.
The rule of thumb
Country by Country
| Country | Funding model | Residents pay | Visitors pay |
|---|---|---|---|
| United Kingdom | Tax-funded (NHS) | Free at point of use; £9.90 prescription charge in England | A&E free; other NHS care charged at 150% unless GHIC/EHIC or reciprocal deal applies |
| Ireland | Mixed public/private | Public hospital care free since 2023; Doctor visits €50–€70 unless medical card | EU/EEA with EHIC treated as public patients; others billed |
| Spain | Tax-funded regional | Free public care; small prescription co-payment | EHIC/GHIC covers state care; private clinics charge |
| Italy | Tax-funded (SSN) | Free care with a "ticket" co-payment for tests and specialists | EHIC/GHIC accepted at public facilities |
| France | Statutory insurance | Reimbursement model — you pay first, get ~70–100% back | EHIC/GHIC gives the same reimbursement rights |
| Germany | Statutory insurance | Insurance is mandatory; care largely free at point of use | EHIC/GHIC accepted; private-only doctors charge |
| Portugal | Tax-funded (SNS) | Near-free; ER fee around €18 | EHIC/GHIC accepted |
| Sweden / Norway / Denmark | Tax-funded | Small capped co-payments per visit | EHIC covers state care; GHIC does not cover Norway |
| Canada | Tax-funded (Medicare) | Free hospital and physician care; drugs and dental not covered | Not covered — travel insurance essential |
| Australia | Tax-funded (Medicare) | Free public hospital care | Only via reciprocal agreements (UK, Ireland, NZ and others) for emergency care |
| Japan | Statutory insurance | Insured residents pay 30% of costs | Not covered — pay in full |
| Brazil | Tax-funded (SUS) | Free at point of use | Emergency care free to everyone, including tourists |
| Thailand | Universal coverage scheme | Near-free for Thai nationals | Not covered — private hospitals charge |
| United States | Private insurance | No universal system; Medicare/Medicaid only for eligible groups | Nothing free — ER visits commonly $2,500–$10,000+ |
Charges are indicative and change with national budgets. Check the current position for your destination on our country healthcare pages.
If You Are Moving There: Expats and New Residents
Eligibility follows registration, not arrival. In Ireland you need a PPS number and, for reduced charges, a medical card or GP visit card. In the UK you register with an NHS GP practice and, for most visa routes, pay the Immigration Health Surcharge up front. In Spain you need a tarjeta sanitaria via social security; in Germany and France statutory insurance enrolment is compulsory but takes weeks to process.
The coverage gap nobody plans for
Read the detail for the two systems most people arrive into: our Ireland new-arrivals guide and UK new-arrivals guide.
If You Are Just Visiting: Travellers
EU/EEA and Swiss citizens carrying a valid EHIC, and UK residents carrying a GHIC, are treated on the same terms as locals in public facilities across the EU — free where locals are free, co-paying where locals co-pay. GHIC does not cover Norway, Iceland, Liechtenstein or Switzerland.
Everyone else pays. Emergency treatment is provided regardless, but the bill follows: an ER visit is free in the UK, roughly €18 in Portugal, can exceed €500 in Switzerland, and runs $2,500–$10,000+ in the United States.
Full detail in our EHIC and GHIC guide and travel insurance guide.
What Is Never Free, Anywhere
- Medical repatriation home — no public system pays for it; only insurance does.
- Private clinics and private rooms, even in tax-funded countries.
- Most dental, optical and cosmetic treatment.
- Pre-planned treatment abroad without prior authorisation (the S2 route in the EU).
- Care for tourists in Japan, Thailand, Canada, Australia (outside reciprocal deals) and the United States.
Where Viscacare fits
Frequently Asked Questions
Which countries have free healthcare?
No country has healthcare that is genuinely free — it is paid for through taxation or mandatory insurance. Countries where residents receive care with little or no charge at the point of use include the UK, Ireland (public hospital care), Spain, Italy, Portugal, France, Germany, the Nordic countries, Canada, Australia, Brazil and Japan. Access depends on residency or insurance status, not on being physically present in the country.
Is healthcare free for foreigners or tourists?
Usually not. EU/EEA citizens carrying a valid EHIC, and UK residents carrying a GHIC, are treated on the same terms as locals in EU public facilities. Everyone else pays. Emergency treatment is generally provided regardless of ability to pay, but you will be billed afterwards in most countries.
Do expats get free healthcare?
Once you are legally resident and registered — with a PPS number in Ireland, an NHS number in the UK, a tarjeta sanitaria in Spain, or statutory insurance in Germany and France — you access the public system on the same terms as citizens. Registration typically takes weeks, and there is often an eligibility waiting period, which is the gap most new arrivals get caught in.
Which country has the best free healthcare?
On access and outcomes, the Nordic countries, the Netherlands, France and Germany rank consistently near the top; Spain and Portugal offer strong care at very low cost. The trade-off is usually waiting time for non-urgent treatment, which is why private and online Doctor access is widely used alongside public systems.
What should I do if I am not yet covered in my new country?
Keep travel or private cover in place until your registration completes, carry your EHIC or GHIC if you are eligible, and use online Doctor access for routine issues such as prescriptions, sick certificates and referrals. Viscacare members get online Doctor access across Ireland, the UK and Europe through our clinical partner Health Hero, which covers exactly this gap.
Care that travels with you
Online Doctor access, 170+ country health guidance and your own health Vault — in one membership, with a 14-day free trial.
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