According to Bloomberg, Singapore offers the world’s most efficient healthcare as a share of GDP and per capita (out of 51 countries measured). Another Asian expat hotspot, Hong Kong, also ranks in the top five countries in Bloomberg’s chart. The UK came tenth.

The Legatum Institute also ranked Singapore second (out of 149) in its 2016 Prosperity Index for health, and Hong Kong fourth. The UK came 20th.

With these two former colonies noticeably outranking the UK for healthcare, is it then fair to suggest British expats may not be missing their much-loved NHS? How is healthcare delivered in these countries compared to the UK and does that offer British expats a better deal?


With such high rankings and ratings, it’s not likely the 50,000 Brits living in Singapore are missing the NHS.

Unlike the NHS, Singapore’s healthcare system is based upon the principle that the individual is responsible for their own health. As such, they are required to pay into their own healthcare fund. While Principle Four of the NHS is “to support and help individuals to manage their own health”, this doesn’t explicitly or directly put the onus on the individual. It simply states that the NHS is there to help the individual.

In Singapore, the government only pays a small portion into individuals’ healthcare fund, but the majority is paid for by the individual and partially by their employer, which explains why the country’s health expenditure is only 4.49 percent of its GDP.

In contrast, the NHS is funded primarily through general taxation and employees’ National Insurance contributions. The UK government funds 98.8 percent of the NHS, effectively making it free at the point of use. The remaining 1.2 percent of funding comes from patient charges e.g. prescriptions, optical services and dental services.

Singapore’s system ensures that there are enough facilities including public hospitals, doctors, nurses, and healthcare workers available to meet the needs of the growing population. This approach seems to reduce the likelihood of issues occurring such as bed shortages, something of which UK hospitals regularly experience.

The NHS doesn’t always compare so favorably. According to BBC analytics, this year during the winter, the number of patients on hospital wards in England has been at unsafe levels at nine out of 10 NHS trusts. Patients have recently been complaining about overcrowding, long waiting times, and the disorder that they have been experiencing including operations being cancelled at the last minute.

Hong Kong

According to Bloomberg, Hong Kong has the highest life expectancy in the world at an average of 83.48 years, which is attributed to their high-quality standard of healthcare. The country also boasts a larger percentage of people who choose to use the country’s private healthcare sector than the UK.

As of 2014, around 11 percent of the UK’s population have some form of private medical insurance, compared to Hong Kong where around 34 percent of the population are covered by private medical insurance. This could help explain why Hong Kong’s cost of healthcare, as a percentage of GDP, is 5.3 percent compared to the UK’s 9.44.

Hong Kong’s greater balance between public and private healthcare services makes them less dependent on government funding and the potential side effects of such a dependency. In contrast, the NHS gets 98.8 percent of its funding from government, and in 2016 revealed a £2.45 billion record deficit.

Like the NHS, Hong Kong’s healthcare system seeks to provide adequate medical treatment to everyone no matter their financial situation. In that respect, British expats would not be losing out because services are being delivered according to the same principle guiding the NHS.

Hong Kong’s system is mainly funded through tax, but unlike the NHS there are out-of-pocket fees that have to be paid upfront. For instance, public charges for “eligible persons” using the accident and emergency service are usually around $100 per attendance.

Eligible persons include holders of the Hong Kong Identity Card, children who are Hong Kong residents and under 11 years of age, or other persons approved by the chief executive of the Hospital Authority.

Non-eligible persons may face considerably higher charges. For instance, a non-eligible person using the accident and emergency service could be charged up to $990 per attendance. As such, and if applicable to their eligibility status, expats may need to have international health insurance in place to help cover any costs and ensure they have access to the right medical care when they need it.

For the most part, having to pay out-of-pocket charges is not something British expats would be used to. This could be viewed as a negative, although the extent to which payments might need to be made may vary in relation to the patient’s specific needs.

Sabrina Bucknole is an outreach executive and writer from the United Kingdom. She specialises in writing about travel, expats, finding work abroad, and healthcare. This article was provided by Aetna International