Do expats add strain to their host country's healthcare system?
Singapore and Hong Kong are renowned for their quality and modern healthcare systems. However, the politico-social crisis in Hong Kong has only made things worse. More and more Hong Kongers are moving to Singapore, which, in response to the Covid crisis, has adopted controversial measures to ensure employment and health coverage for its citizens and residents. It's worth noting that nearly 30% of expatriates in Singapore are ineligible for the healthcare system. These expatriates, therefore, have to subscribe to private health insurance. However, not all of them provide coverage in Singapore. Still, the pressure on the Singaporean health system is not due to expatriates but to the health crisis, also considering Singapore's aging population.
Brazil is more open to expatriates since the start of the crisis. Besides, its digital nomad visa has been attracting many foreigners. To avoid adding more pressure on the public healthcare system, the Brazilian government shifted its burden on private healthcare. As the Brazilian care system is two-tiered, expats have to get their own private health insurance before moving. While the public health system provides universal care for Brazilians and expats, the infrastructure is poor and waiting times can be long. Needless to say that the private health system is known for its quality healthcare and shorter waiting times. Mexico and Argentina have similar issues: wealthy people can afford the costs of healthcare, but the rest has to deal with an overwhelmed public health system.
How are expats cared for?
Canada and France, for example, have an agreement that relates to providing quality healthcare for expats. Therefore, French expats in Canada are entitled to Canadian social protection, guaranteed by the Canada Health Act, including free healthcare at general practitioners and in hospitals. Reimbursement is also provided for essential drugs. This is indeed a boost for expats in Canada, where healthcare is far from being cheap. But keep in mind that the costs of different treatments vary by province.
Meanwhile, Singapore is relying on the construction of new hospitals, nursing homes, and other care facilities, mainly as a response to its demographic challenge. In 2020, 16.8% of the 3.52 million Singaporeans were aged over 65. The city-state is, therefore, betting on "moderate immigration" to revive its demography. In addition, anticipating current and future health needs, Singapore introduced the "Research Innovation and Enterprise 2020" plan to provide funds aimed at modernizing the health sector, among other things.
The United Arab Emirates (UAE) chose to make health insurance compulsory for expats, considering that 90% of its population is of foreign origin. Expats in the UAE seek healthcare from both public and private hospitals. To lessen their financial burden, Dubai and Abu Dhabi also introduced compulsory insurance. In fact, not having health insurance is liable to a fine, and expats are likely to lose their resident status. Dubai employers are obliged to provide minimum health coverage to their employees. But most expats find this offer too limited, so they opt for private health insurance.
Responding to inequalities
Although expats are not yet a real burden on health systems, Singapore and Brazil remain cautious. The health crisis made them realize that reforms are much needed to cope with the increasing pressure. For expats and locals, finance seems to be the main issue as to whether they will be entitled to quality healthcare or not. The Covid pandemic only reinforced this structural inequality.
