With expat populations in Asia and the Middle East growing exponentially year-on-year, it’s easy to forget that Europe is still a key destination for expatriates. Now Health’s global business development director, Christopher Claridge-Ware, looks at Europe’s expatriate population, what healthcare provision people can expect when moving to popular locations, and why international private medical insurance is so important for many
Recent global research carried out by Finaccord* revealed the number of worldwide expatriates amounted to around 50 million in 2013; a figure that grew at a compound annual rate of 2.4% between 2009 and 2013 and is forecast to reach an estimated 56.8 million by 2017. Finaccord forecasts that students will remain the fastest growing category of expatriates between 2013 and 2017, increasing at a compound annual rate of 3.6%, followed by individual workers (3.2%), retired expatriates (2.9%), corporate transferees (2.8%) and other expatriates (2.3%).
The growth in worldwide expatriates numbers is being heavily influenced, according to Finaccord, by global mobility increasing enormously over the past decade. Regional fluidity has been affected by a number of free movement treaties, such as Europe’s Schengen Agreement, that have enabled people to live and work abroad more easily.
Europe as an expat destination
The word ‘expatriate’ congers up thoughts of far-flung destinations and emerging market locations in Asia and the Middle East – especially when thinking of those moving away from the UK to work. But both the developed and developing regions in Europe demand overseas investment and workers, and are a key destination for both long and short-term expatriates.
Europe is a hugely popular destination for expatriate workers of all nationalities. According to www.internations.org 2014 expat insider survey** there are 3 European countries within their top ten expat destinations – #2 Luxembourg, #4 Switzerland and #7 Spain and another 5 within the top 20. It is interesting that both Luxembourg and Switzerland are fairly small land- locked countries without the draw of constant good weather and beaches.
For professional workers the perks of becoming an expatriate – often including generous compensation packages, paid housing and education, and the opportunity to experience different cultures which can help to outweigh the need to move away from friends and family. And Brits moving to Europe are often able to enjoy expatriate benefits and a close proximity to home.
The International Passenger Survey (IPS) from the ONS, which tracks migration from the UK and the reasons for it, shows that most residents who leave the UK are of working age with many going to take up a position they had already been offered. Britain is the largest exporter of people in the European Union and the third largest in the world according to the Finaccord* research, and there were 1.16 million UK nationals living overseas last year (2013). By 2017 it is estimated that there will be around 1.21 million UK expatriates abroad.
The most popular destinations for UK residents moving to Europe are Spain, Ireland, France, The Netherlands and Germany. Spain which is the most popular EU destination for UK expats – has 100,000 UK expats, closely followed by France and then the Netherlands. By contrast there are only 3-4,000 living in Romania.
European healthcare and international private medical insurance
It would be easy to think that international private medical insurance is less relevant for expatriates in Europe than other parts of the world. After all, the standard of European healthcare is generally high. However, with around 50 countries in Europe, the treatment you’ll receive and how easily you can access it can vary dramatically from place to place.
Expats moving to France, Poland or Spain for instance, will have very different experiences if they need to access care.
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France
Healthcare in France is comprehensive – in 2000, the World Health Organisation found France provided the “best overall health care” in the world. France’s system of universal health care is largely financed by government national health insurance. Public insurance, financed by both employees and employer contributions, is compulsory and covers nearly the entire population, while private insurance is complementary and voluntary. A voluntary top-up health insurance scheme is available to expats registered in the ‘Assurance Complementaire’ health system. This scheme does not allow expats to ‘jump the queue’ but reimburses the part of the cost not paid by the government scheme. In 2017* it is estimated that the UK will have the third largest expat population in France with over 62,000 residents.
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Poland
Poland’s healthcare is good but not quite at the same level of many of its western neighbours. EU/EEA citizens are entitled to use Polish health care services with their European Health Insurance Card. Emergency treatment and treatment in cases of sudden illness is usually free of charge, however, it is not on a par with Western Europe and time delays between calling the emergency services and receiving treatment are significantly longer. Expats living in Poland will need to join the national system – the same as Polish citizens – and non-EU nationals not covered by an employer health scheme should take out health insurance. Expats emigrating to Poland without a job must produce proof of IPMI in order to obtain their residence permit.
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Spain
Spanish healthcare is regularly ranked amongst the best in the world, guaranteeing universal coverage and no up-front expenditure from patients, apart from a proportion of prescription charges. A World Health Organisation survey in 2012 revealed that Spanish women outlive all nationalities apart from the Japanese – living to 85 years. State health care is free of charge to anyone living and working in Spain, although in some of the Spanish islands you may have to travel to find a state healthcare provider. Expats are usually entitled to free state healthcare.
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iPMI in Europe is less about evacuation or repatriation from remote areas with poor healthcare and more about customer choice and flexibility. Expatriate plan holders who travel extensively or have short working stints in different countries will certainly benefit from the cross-border flexibility and portability of an iPMI plan. Those resident for longer periods will enjoy higher plan limits than local plans, greater choice of healthcare facilities for specialist treatment and the option of repatriation to their home country for care in a variety of circumstances. And in some instances, iPMI will have developed plans specifically targeted to expatriates needs in certain countries – such as the top-up plan for French expatriates – so it’s always worth discussing your client’s position with your insurance provider.
With a good standard of care in many countries in the European region, it’s all too easy to discount the need for international private medical insurance. But the IPMI argument remains strong for expatriates with specific requirements and a comprehensive plan for individuals and their families is often the best way to ensure clients will receive the best care if and when they need it.
*Finaccord Expat Research 2013
**www.internations.org/expat-insider/2014/the-best-and-worst-places-for-expats