If you are building a UK business with international contractors or employees, understanding the most expensive healthcare countries is not a travel curiosity; it is a budgeting and duty-of-care decision. The NHS shields most people in the UK from direct medical bills, but that protection disappears quickly once you hire, send staff, or trade in markets where patients pay at the point of use.

Women-led businesses in the UK are expanding internationally more often, but healthcare costs abroad rarely get the same attention as tax, employment law, or banking. If you are hiring or trading overseas, the cost and structure of healthcare in your target country should be on your due-diligence checklist from the start. For context, see Women in Business: Key UK Facts.

Why Healthcare Costs Matter to UK Employers Abroad

When you employ or contract with someone overseas, their healthcare arrangements affect your costs, your risk, and your ability to attract talent. In the UK, NHS care is funded through general taxation and National Insurance. For 2025/26, HMRC charges employer National Insurance at 15% on earnings above the £5,000 secondary threshold, and Statutory Sick Pay is set at £116.75 per week by gov.uk guidance. That framework does not transfer automatically to another country.

In markets with high private healthcare costs, a single accident or serious illness can create financial shock for a contractor, trigger disputes about who pays, or force you to offer health cover simply to remain competitive. Knowing the most expensive healthcare countries helps you price contracts, choose insurance, and write employment terms before a crisis occurs.

Which Are the Most Expensive Healthcare Countries?

The most reliable cross-country comparison comes from the OECD, which publishes health expenditure data on a per-person basis using purchasing power parity. According to OECD Health Statistics 2024, covering spending in 2023, the following countries lead the table:

United States

The United States remains the most expensive healthcare country in the world by a wide margin. OECD data for 2023 puts US health spending at the equivalent of roughly $12,555 per person, more than double the UK level. Unlike the UK, there is no universal tax-funded system; most working-age adults receive cover through employer-sponsored insurance, and out-of-pocket charges are common even for the insured. If you are hiring US staff, health benefits are not a perk; they are an expected part of compensation.

Switzerland

Switzerland has the second-highest health spending in the OECD, at around $8,049 per person in 2023. Cover is mandatory and purchased through private insurers, with patients paying significant deductibles and co-payments. For a UK business, this means any Swiss employee or contractor will need a compliant health policy, and you should budget for premiums that are far higher than UK private medical insurance.

Germany, France, and the Netherlands

Germany spent around $7,730 per person in 2023, France around $6,500, and the Netherlands slightly higher than France. These countries use social health insurance models, combining mandatory contributions with regulated private insurers. Costs are lower than the US or Switzerland, but employer contribution rates are still material and vary by country. You will need local payroll advice to calculate the true cost of hiring.

United Kingdom in Context

The UK spends less per person than the leading countries above. NHS England’s budget for 2024/25 is £181.7 billion, and OECD data places UK health spending at roughly $5,400 per person in 2023. That lower headline cost is one reason the UK remains attractive for international hiring, but it also means UK founders can be unprepared for the bills their overseas teams may face.

Out-of-Pocket Costs: What Your Team Actually Pays

High total spending is only part of the picture. The share paid directly by patients at the point of care matters just as much for your contractors and employees. WHO Global Health Expenditure Database figures for 2023 show that out-of-pocket spending as a share of current health expenditure varies sharply. It is highest in lower-income markets, although some high-income countries also require significant patient contributions:

• India: around 48% of health spending is paid out of pocket.
• Mexico: around 40%.
• Vietnam: around 36%.
• Switzerland: around 28%.
• United States: around 10%.

The US figure looks low as a percentage, but because total costs are so high, the average out-of-pocket bill can still be substantial. In India, the percentage is high but the absolute cost of a routine procedure may be lower than in Europe. For your business, the lesson is to look at both the total cost of care and the share your team member would have to fund themselves.

UK Employer Obligations and Insurance Choices

You are not required to provide private health insurance to UK employees, and the NHS covers most care. However, if you hire abroad, local rules may require you to contribute to a social insurance scheme or provide private cover. Even where it is not mandatory, offering international health insurance can help you recruit and retain staff in expensive healthcare countries.

Before you expand, check the following:

• Local employment status: A contractor in one country may be classified as an employee in another, changing your obligations.
• Mandatory insurance: Some countries require employers to enrol staff in statutory health insurance.
• Travel and secondment cover: If UK staff work abroad temporarily, ensure your policy covers them.
• Tax treatment: Employer-paid health premiums may be a taxable benefit in the UK or overseas.

For a deeper look at whether health cover makes sense for a small UK team, see Should You Offer Health Cover as a Small Employer?

Action Steps

1. Map every country where you currently have staff, contractors, or customers, and identify whether healthcare is state-funded, insurance-based, or mixed.
2. Request quotes for international private medical insurance before you sign contracts abroad, so healthcare costs are built into your pricing.
3. Review local employment law or use an employer-of-record service to confirm whether you must contribute to social health insurance.
4. Update your contracts to state clearly who is responsible for medical costs if a contractor is injured or falls ill.
5. Read the State of Women’s Enterprise 2025 report to understand how women-led businesses are scaling, and where export growth is strongest.

Conclusion

The most expensive healthcare countries are not just a list for travellers; they are a planning tool for any UK woman-led business expanding internationally. The United States and Switzerland top the cost rankings, but out-of-pocket shares and local rules vary widely. By checking healthcare costs before you hire abroad, you protect your team, your cash flow, and your reputation as an employer.