The Burrow
Dec 4, 2025
With living costs rising worldwide, healthcare remains one of the biggest expenses families face. Even in countries with universal healthcare, patients often have to pay out of pocket for key treatments, such as hospital stays and specialist consultations. And if an illness is severe enough to put a patient out of work, even temporarily, then the financial burden of a hospital visit can be incredibly stressful.
The health insurance experts at Compare the Market have ranked countries worldwide by out-of-pocket medical expenses and compared them with areas with the cheapest healthcare.
To do this, we looked at the average medical spend per capita, the percentage of an average salary spent on healthcare, and the convenience of medical facilities. We then assigned each country a score from 0 to 100 on our out-of-pocket healthcare cost index. Low scores indicate areas with high average healthcare spending, while high scores indicate areas with cheaper medical costs.
Here are our rankings. If you’re looking for our 2021 index, you can find it here.
Typically, countries that provide universal healthcare experience the least out-of-pocket medical spending, but our top five include some potentially surprising exceptions. Here are the countries that fared the best in our rankings:
With excellent scores across the board, the Netherlands ranks as the least-affected country by out-of-pocket medical spending worldwide.
A typical Dutch patient will spend around AUD$425.34 of their own money on medical bills each year, which equates to just 0.59% of the average salary in the country.
It also boasts the most accessible medical services in the world, scoring 88.28 out of 100 on our healthcare location convenience index. These combine to give it a total score of 89.94 out of 100 in our rankings, securing the top spot.
Second-ranked France finishes less than half a point behind our no.1 country, making it a particularly tight race for the top.
With a typical French person paying just AUD$268.48 each year, it ranks as the country with the second-cheapest medical bills worldwide, and the country that pays the second-smallest portion of its salary to healthcare services (0.52%).
It also scores highly on our convenience index, with a rating of 81.38. These add up to an impressive overall score of 89.56 for a silver medal finish.
Croatia has plenty to brag about when it comes to healthcare, ranking as the country with the lowest annual healthcare expenditure on our list.
The average resident pays just AUD$246.37 towards medical bills each year, which is equivalent to only 0.8% of a typical annual salary in the country.
However, it loses a few points for medical accessibility, earning a score of 77.78 on our healthcare convenience index. Despite this, its final rating of 83.31 out of 100 is enough to earn Croatia a podium finish!
Europe continues to dominate the top of our rankings, as Belgium earns a fourth-place finish. Its citizens can expect to pay just AUD$421.43 in annual healthcare costs, which is about 0.78% of the average salary in the country.
A strong performance in our healthcare location convenience index (80.74) helps to solidify its place in the top five, scoring a respectable 78.85 out of 100 overall.
Last in our top five is the United Kingdom, which scores 76.51 out of 100. The UK boasts a convenience score of 79.07, but its limited out-of-pocket spending is what helps it rank so highly on our list.
The average Brit pays just AUD$435.84 for medical services annually, as the country’s National Health Service covers a range of procedures. This helps it to beat close competition from Switzerland (76.28) and Germany (75.80) to finish our rankings.
Now that we know which countries spend the least on healthcare, let’s compare them with the countries at the opposite end of the list. Here are the five countries where residents can expect to be the most ‘out-of-pocket’ on healthcare:
Greece is the country that tops our rankings for out-of-pocket medical spending. With the fourth-lowest score on our healthcare convenience index worldwide (67.61 out of 100), healthcare in the country is difficult for many citizens to access.
Only Mexicans spend more of their average salary on medical bills, with a typical Greek citizen spending 3.31% of their annual income on services. That equals around AUD$691.50, giving Greece its final score of 23.60 on our rankings.
With a score of 34.77 out of 100, Hungary is the second-lowest-ranked country on our index, with many of its residents struggling to cover medical costs.
Its healthcare convenience rating of 66.83 is the third-lowest worldwide, while its average medical expenditure per capita of AUD$602.09 amounts to approximately 2.55% of the country’s typical annual salary. Its healthcare convenience score of 66.83 is also the second-lowest among countries in our rankings.
The average Slovakian can expect to pay around 2.45% of their income towards medical expenses each year, totalling around AUD$620.87.
This, combined with a convenience rating of 72.22 out of 100 for the location of its healthcare services, makes Slovakia one of the most expensive and inaccessible countries in Europe for receiving medical attention. Its final index score is 41.59, ranking it third among our lowest scorers.
While other countries on our list have higher medical expenditures on paper, Mexico’s low average salary earns it a fourth-place finish.
The average cost of healthcare per capita in Mexico is AUD$509.43, which may not seem like a significant amount, but it accounts for a substantial 3.64% of the country’s typical salary.
This means it’s the country that spends the highest portion of its income on healthcare services. Despite scoring 80.03 on our healthcare convenience index, its total score of 44.07 places it in the bottom five.
Rounding out our list is Romania, scoring 44.35 out of 100 in our overall index. Its ranking is partly due to a relatively inaccessible healthcare system, with a score of just 71.03 on our convenience index, but affordability is its central issue.
The average Romanian spends around 2.55% of their annual salary on medical expenses, which amounts to roughly AUD$508.02. This means it ranks lower than other countries with inaccessible healthcare, such as Poland (44.95) and Italy (45.71), and places it in the bottom five.
When it comes to our regional data, Hawaii is the least-affected state by out-of-pocket medical spending. The median healthcare expenditure per capita for a Hawaiian family is USD$800, the lowest among all states. These bills account for around 0.83% of a typical household’s income in the area. Other states with low average out-of-pocket medical spending include California, where 0.94% of household income is spent on healthcare, and New York, which sits at 1.09%.
On the other hand, Wisconsin ranks as the state with the highest medical expenditure per capita, with the median household spending USD$3,700 on healthcare annually. For a typical household in the state, this comes to around 5.01% of their annual income. It’s closely followed by Nebraska, which spends more of its income on healthcare on average (5.05%), but its median overall cost of USD$3,660 gives it a slightly lower total score.
South Australia boasts the lowest rate of out-of-pocket healthcare costs in the country, with the median family spending just AUD$133 on medical services each year. Only 2% of healthcare providers in the region have no agreements with insurers in place to reduce medical costs, which means it’s easy to get a good deal on your care. Plus, the average resident spends just 0.2% of their income on medical bills each year.
The worst-affected area is the Australian Capital Territory, where the median family can expect to spend around AUD$591 out of pocket on medical bills each year. The ACT is also affected by a low rate of insurance agreements, with a massive 12% of local providers refusing to reduce the cost of medical treatments.
Nobody wants medical treatment to impact their finances. Steven Spicer, Executive General Manager of Health, Life and Energy at Compare the Market, says it’s crucial to make sure you’re covered by a strong health insurance plan to reduce costs.
“Health insurance plays a vital role in keeping healthcare affordable for everyone. If you don’t have appropriate coverage, you could be spending hundreds or potentially thousands of dollars more out of pocket than other patients for the same treatments,” he said.
“At Compare the Market, we help you take control of your medical bills by comparing insurance from some of the country’s leading providers, so you can look for a plan that works for you at the best possible price. It takes just a few clicks to start comparing and saving money on your health insurance, so start your search for a better quote today!”
This dataset contains three rankings: one ranks 30 countries worldwide, another ranks US states & the other ranks Australian states/territories based on the required out-of-pocket healthcare payments, using three key factors (two for US states).
Each factor’s data was collected and normalised to a score between 0 and 1. If data was missing, a score of 0 was given. These scores were then combined to give each location a total score out of 100, and locations were ranked from highest to lowest.
All data is correct as of 29/10/25. The ranking data shown is a compilation of multiple data sources and may not be representative of real life. All data is accurate with regard to the sources provided.