Americans arrive in Europe with one big assumption: “If it’s cheaper, it must be worse.”
Then they get whiplash.
They see modern hospitals, calm clinics, and pharmacists who act like actual humans. They also meet the other side of the deal: slower systems, more gatekeeping, and admin that assumes you are already part of the machine.
“Best healthcare” in Europe is not one country. It’s a set of trade-offs. The best country for a healthy 52-year-old who wants low monthly costs is not the best country for a 67-year-old managing cardiac meds, arthritis, and a spouse who panics when the appointment is three weeks out.
This is the honest scoreboard, and how Americans should pick.
What “best” really means when you’re not 28 anymore
If someone is choosing a country based on hospitals, they should stop thinking like a tourist and start thinking like a long-term patient.
“Best” is not a vibe. It’s a combination of five things:
- Outcomes that don’t require heroics
Think treatable mortality and how well a system handles the conditions that should not kill you if care is timely and competent. - Access that works in normal life
Not “world-class care exists,” but “Can you get seen without a month of chasing?” Watch unmet need and wait times. - Financial protection when things go wrong
Americans are trained to fear the big bill. Europe generally protects you better, but not equally. The metric that matters is catastrophic spending, households pushed into financial hardship by out-of-pocket costs. - The friction of using the system
How many steps, how many referrals, how much paperwork, how much phone-tag. Some countries are brilliant medically and still exhausting operationally. - Language and navigation
A system can be excellent and still feel unsafe if you cannot explain symptoms precisely or understand next steps.
If someone wants “the best healthcare in Europe,” they need to rank these five based on their actual life, not their fantasy self.
A healthy couple can tolerate friction. A couple dealing with chronic conditions cannot. That’s why people who move for “better healthcare” sometimes end up miserable in a country with objectively strong outcomes. They picked the wrong friction profile.
The quick leaderboard, and what it hides
If you want a starting point, look at comparative performance work, then layer real-world expat usability on top.
One widely cited comparison is the Commonwealth Fund’s Mirror, Mirror 2024 report, which ranks 10 high-income countries across access, care process, administrative efficiency, equity, and outcomes. In that set, the top overall performers were Australia, the Netherlands, and the United Kingdom, while the United States ranked last overall. Among the European countries in the comparison, the Netherlands and the UK placed highest overall, with France, Sweden, Switzerland, and Germany following.
That sounds like a clean answer until you read what “best” costs in real life.
Here’s the honest interpretation for Americans:
- Netherlands can be superb, and still feel like a locked system if you hate gatekeeping.
- United Kingdom ranks high in the comparison, and still struggles with the on-the-ground reality of access and continuity in many areas.
- Switzerland has high satisfaction and a polished system, and it is also one of the most expensive places in Europe to be a patient.
- Germany is clinically strong, but still landed near the bottom of that specific comparative ranking overall, which surprises Americans who assume “Germany equals perfect systems.”
Then there are countries not in that ranking that matter hugely for American retirees, especially Spain and Portugal. Spain routinely performs strongly on health outcomes and population health indicators, and Portugal remains attractive, but both come with wait-time and capacity realities that Americans must price in emotionally.
So yes, there’s a leaderboard. But the real game is: which system fits the way you actually handle uncertainty, waiting, and paperwork.
Spain: strong outcomes, low barriers, and the two-track reality
Spain belongs in the conversation because the outcomes are excellent by European standards and the system is designed to provide broad access.
Spain’s health system review from the European Observatory highlights Spain’s very high life expectancy and notes that avoidable mortality and avoidable hospitalizations are among the lowest in the EU. That’s not marketing copy, that’s system performance.
The part Americans underestimate is how Spain functions day-to-day.
Spain has a clear split between public care and private care. Many residents use public primary care as the base, and private care as a speed layer for certain specialties, tests, and convenience. That hybrid approach can be a sweet spot if you plan it intentionally.
What Spain does well for Americans:
- Chronic disease management can be solid once a patient is inside the loop.
- Prescription access is generally straightforward once a clinician is established.
- Outright “I can’t afford to be seen” is less structurally baked in than in the U.S.
What Spain will test:
- Cita previa culture and the reality that some access is appointment-driven and slower than Americans expect.
- Regional variation. Spain is not one system in practice. It’s a set of regional systems that can feel different in speed and staffing.
- Mental health capacity. Spain’s 2025 Country Health Profile notes that unmet needs for mental healthcare rose and in 2024 were reported by 7.9% of respondents who said they forwent mental healthcare, close to the EU average.
The no-sugar-coating truth: Spain is often a strong choice for retirees who want good baseline care and can tolerate waiting in the public lane, or who can afford private insurance as a speed valve.
If someone requires fast specialist access as a non-negotiable, Spain can still work, but they need a plan for the private lane, not just optimism.
France: high-performing care, but the paperwork and coverage gaps surprise people
France has a deep healthcare culture. It’s not just “hospitals exist,” it’s built around routine medical care as a normal part of life. In comparative work, France tends to land in the upper half overall.
But France is also where Americans learn that “universal-ish” does not mean “everything is free.”
The 2025 France Country Health Profile notes that about 4.5% of adults reported unmet needs due to costs, distance, or waiting times in 2024, slightly above the EU average, and that unmet needs are higher for services that are less comprehensively covered, including dental, vision, and hearing aids. That lines up with what expats feel: the system can be excellent, and you still need to budget for parts of the body that U.S. insurance used to half-cover badly anyway.
What France does well for Americans:
- Strong clinical depth in many specialties.
- A system designed around a long-term relationship with a primary doctor, often framed through the médecin traitant model.
- Generally good medication access and pharmacy integration.
What France will test:
- Admin and forms. France can be orderly and still paperwork-heavy.
- Geography. “Medical deserts” are a real policy issue in France, meaning some regions have serious shortages and longer waits.
- The reality that dental and vision are often where people feel costs most sharply.
France is a top-tier choice for retirees who want a mature system and are willing to learn its rules. It is a rough choice for people who hate forms, hate waiting, and expect English to carry them through complex healthcare conversations.
Netherlands and Germany: excellent systems, very opinionated rules
These two countries often attract Americans who want “serious” healthcare systems.
They are serious. They’re also strict.
Netherlands
The Netherlands ranks extremely well in comparative performance work, including ranking very high on access in Mirror, Mirror 2024.
The trade is culture and structure. The Dutch model is heavily organized around primary care and referrals. If you like clear pathways, it’s great. If you hate being told “wait and see,” it can feel dismissive, even when it’s clinically appropriate.
A sharp reality from the Netherlands 2025 Country Health Profile is that mental healthcare capacity has struggled. It reports that in 2024, 9% of the population requiring mental healthcare reported unmet needs, exceeding the EU average of 7%.
So the Netherlands can be “best” for many things, and still not be the best place if mental health access is your top priority.
Germany
Germany is clinically strong and operationally robust, but in Mirror, Mirror 2024 it ranked lower overall (9th of 10 in that set). That does not mean German care is bad. It means that on that specific mix of access, admin, equity, and outcomes, Germany had relative weaknesses compared to peers.
Germany’s 2025 Country Health Profile notes that in 2024, 1.2% of Germans with a medical care need reported unmet needs due to financial reasons, long waiting times, or travel distance, which is low by EU standards.
What these countries do well for Americans:
- Predictable systems once you’re inside.
- Strong hospital infrastructure and specialist capacity in many areas.
- Less of the “everything is improvised” feeling.
What they will test:
- GP gatekeeping and the psychological adjustment required.
- Insurance complexity and the expectation that you will follow structured pathways.
- Less tolerance for winging it.
They are excellent choices for retirees who want order, and who can adapt to being guided by the system instead of shopping for care like a consumer.
Sweden and Switzerland: world-class experiences, in opposite ways
These two get lumped together in expat conversations because both “sound premium.” They are premium in very different ways.
Sweden
Sweden tends to perform well on population health and digital health adoption, but it has a long-running issue that Americans feel immediately: waiting.
Sweden’s 2025 Country Health Profile states that delays are most pronounced in specialist care, where three in ten patients wait longer than the 90-day guarantee.
That single statistic captures the Swedish deal. The care can be excellent, the system can be equitable and modern, and you still may wait.
Sweden is a strong fit for retirees who:
- Want digital-forward primary care,
- Do not need frequent rapid specialist access,
- Can tolerate a system that prioritizes triage and queues.
Switzerland
Switzerland is often the healthcare “wow” country. The system is high-performing and satisfaction is high, but the price tag is real.
The European Observatory notes Switzerland’s health spending is high, at US$ 8,998 per capita (2021) and out-of-pocket payments were higher than the EU average (23% vs 19%). The OECD’s Health at a Glance 2025 country note also reports high satisfaction with availability of quality healthcare (89%).
Switzerland is a good fit for retirees who:
- Want a polished, high-capacity system,
- Can afford the premium,
- Prefer speed and certainty over bargain living.
Sweden is about patience. Switzerland is about money. Both can be “best,” depending on what you can tolerate.
Portugal and the countries people romanticize too hard
Portugal is beloved for lifestyle, and plenty of retirees have good medical experiences there. But if the topic is healthcare with no sugar coating, Portugal needs honesty.
Portugal’s 2025 Country Health Profile explicitly points to workforce strain, noting long waiting times and the EU’s highest emergency-department use, and that 7% of households are exposed to catastrophic health expenditure due to out-of-pocket payments.
That does not mean “Portugal is bad.” It means the system is under pressure, and retirees who need frequent specialist care should plan for queues and friction.
This is where Americans make a common mistake: they choose a country for sun and affordability, then discover that their personal health profile requires speed.
If someone has:
- multiple chronic conditions,
- a spouse who needs regular follow-up,
- or a low tolerance for waiting,
then “cheap” is not the right primary filter. “Stable access” is.
The broader Europe reality is this: workforce shortages and capacity constraints are a continent-wide challenge, not a Portugal-only story. OECD’s Health at a Glance: Europe 2024 flags health workforce shortages as a major issue across European health systems.
So the honest framing is not “find the perfect country.” It’s “find the system whose bottlenecks you can live with.”
Seven days to choose the right healthcare country for your actual life
This is the practical part. The goal is to make a decision that holds up when someone gets sick, not just when the weather is nice.
Day 1: Write your health profile like an adult
List current meds, diagnoses, and how often you need specialist care. Mark any non-negotiables (oncology network, cardiology follow-up, mental health access, orthopedic care).
Day 2: Pick three countries that match that profile
Do not pick one country. Pick a top choice, a strong runner-up, and a Plan B. Countries are systems, and systems have bottlenecks.
Day 3: Map healthcare reality in two specific cities per country
Not “Spain,” but “Valencia and Málaga.” Not “Portugal,” but “Porto and Coimbra.” Specialist access can vary by region.
Day 4: Price the private layer honestly
Even if you plan to rely on public care, price what it costs to add a private lane for speed. This is where many budgets break quietly.
Day 5: Run the language test
Can you explain symptoms clearly? Can you understand next steps? If not, decide now how you’ll handle it. Interpreter budget, bilingual clinician search, or a country where English is more common in medical settings.
Day 6: Stress-test the waiting reality
If a specialist appointment takes weeks, can you stay calm? If the answer is no, don’t pick a system where waiting is a central feature.
Day 7: Decide what you are trading
Every country trades something: cost, speed, admin complexity, language ease, or geographic access. Choose the trade you can live with.
The only wrong move is pretending you won’t age and you won’t need the system. The system is the point.
About the Author: Ruben, co-founder of Gamintraveler.com since 2014, is a seasoned traveler from Spain who has explored over 100 countries since 2009. Known for his extensive travel adventures across South America, Europe, the US, Australia, New Zealand, Asia, and Africa, Ruben combines his passion for adventurous yet sustainable living with his love for cycling, highlighted by his remarkable 5-month bicycle journey from Spain to Norway. He currently resides in Spain, where he continues sharing his travel experiences with his partner, Rachel, and their son, Han.