In the places that score the highest in the Healthcare category of this year’s International Living Annual Global Retirement Index, folks are simply paying out of pocket for medical bills.

Healthcare is one of the most significant elements potential expats consider before moving abroad and in the right places overseas it’s possible to access world-class care for a fraction of the cost back home.

Across the 25 countries we rank and rate in our annual Index, we assess the cost, access, and quality of care as well as insurance and the cost of medications in the places where we recommend expats go.

The six countries that scored the highest marks for Best Healthcare in the World in this year’s Annual Global Retirement Index are…

Penang, Malaysia

Penang, Malaysia

 #1 Malaysia

Malaysia takes the top spot in the Healthcare category of the International Living 2019 Annual Global Retirement Index.

With 13 JCI-accredited hospitals in the country, up-to-date sophisticated infrastructure, and almost every doctor fluent in English—the healthcare in the Southeast Asian gem is simply world-class. It’s not surprising Malaysia is a popular tourism destination.

Here, you don’t need an appointment to see a specialist, and you don’t need a referral from a general practitioner, either. It’s as simple as registering at a hospital and waiting in line to see your specialist of choice.

Prescriptions in Malaysia cost a fraction of U.S. prices. But it’s not just the cost that’s attractive—it’s the service. The pharmacists, like the rest of Malaysia’s medical staff, are well trained and informed. Malaysians are friendly people, but it’s the genuine interest that they take which impresses.

Carcassonne, France.

Carcassonne, France.

#2 France

The low cost of health insurance and the superb quality of care means that France consistently receives high scores in the Healthcare category of International Living’s Annual Global Retirement Index. And with the World Health Organization.

Life expectancy now averages 85.7 years for women and 80.1 for men according to the latest WHO data published in 2018, giving France a World Life Expectancy ranking of 5—the United States ranks at 34.

“There is a reason France is consistently named by the World Health Organization as having the best healthcare in the world,” says Stewart Richmond IL South of France Correspondent.

“It is accessible to all and affordable. Prescription medicine is heavily subsidized and is among the cheapest in the world. For those developing long-term illnesses such as cancer or MS, all healthcare and medicine is provided free of charge.”

Hua Hin, Thailand

Hua Hin, Thailand

#3 Thailand

“Thailand leads the way in medical tourism for Southeast Asia,” says Michael Cullen, IL Thailand Correspondent. “That means quality, international standard hospitals with well- trained, English-speaking medics in all the major cities and regional towns right across Thailand.

“Dental and other health services are also well covered—and all to that same high international standard.

“For expats living in Thailand it is sensible to have health insurance as there is no national system within the country they can tap into.

“But with healthcare costs averaging from a quarter to less than a half of what they would cost in the U.S., the insurance costs will not break the bank.”

Although there is no public health insurance available to expats, there are several options to obtain private insurance from a variety of excellent companies, both domestic and international.

Thailand’s private healthcare system consists of a large number of well-equipped, state-of-the-art hospitals. A real plus is you’re often able to visit a specialist within a short time of walking through the front door—without booking an appointment beforehand.

Salinas, Ecuador.

Salinas, Ecuador.

#4 Ecuador

One of the great perks for foreign residents living in Ecuador is high-quality, low-cost healthcare.

“In February of 2016, Ecuador passed a law that all new residents must have some form of healthcare coverage,” says Jim Santos, IL Salinas Ecuador Correspondent. “However, the same law prevents all private insurers from denying coverage because of age or pre-existing conditions. This opened up the private market, although expats may still also choose to sign up for the state-run health plan, which covers all medical, dental, and eye-care expenses (including prescriptions, testing, rehab, etc.) at IESS hospitals and clinics with no deductible and no co-pay.

“Expats are eligible to use the system after paying into it for the first three months.”

In the bigger cities, you’ll find hospitals with state-of-the-art equipment, as well as specialists in all fields and physicians with private clinics. But expats don’t need to live in a metropolis to take advantage of good quality healthcare. Smaller cities also have private clinics and modern hospitals. And in small towns you’ll often find private doctors who go that extra mile with some even making house calls if you’re too ill to go out.

Costa Rica and Mexico are tied for fifth place.

Central Valley, Costa Rica.

Central Valley, Costa Rica.

#5 Costa Rica (tie)

By almost any standard, Costa Rica has some of the best healthcare in Latin America. There are two systems, both of which expats can access: the government-run universal healthcare system, Caja Costarricense de Seguro Social, known as Caja, and the private system. Both health systems are constantly being upgraded—new hospitals, new equipment, and improvements in staff training.

Many doctors, especially in private practice, speak English and have received training in Europe, Canada, or the U.S. But despite the advancements, costs are low in comparison to those back home.

Texan doctor John Michael Arthur, M.D., who now lives in the Central Valley, Costa Rica, has a lot of praise for the Costa Rican Healthcare system.

“High-quality healthcare—medical, surgical, and dental—is easily found and at about one-third the cost of U.S. prices in the private system,” he says.

“For example, I recently had a new state-of-the-art zirconium crown placed for about $275. And I had an echocardiogram for only $145 and I left with the complete analysis and report in my hands.”

Riviera Maya, Mexico.

Riviera Maya, Mexico.

#5 Mexico (tie)

A favorite for expats looking for a haven close to the U.S. and Canada, Mexico offers an affordable cost of living and great healthcare.

Most doctors and dentists in Mexico received at least part of their training in the U.S. Many of them continue to go to the U.S. or Europe for ongoing training.

Every medium to large city in Mexico has at least one first-rate hospital with the cost of healthcare generally half or less what you might expect to pay in the U.S. The same goes for prescription drugs.

Plus, health insurance in Mexico costs much less than it does in the U.S.

“Mexico offers two national healthcare plans for residents,” says Don Murray, IL Riviera Maya Correspondent. “The one most popular with expats seems to be the Seguro Popular program where annual costs may be only a few hundred dollars for full coverage.”