The Truth About Europe’s “Free” Healthcare

I’ve been seeing a physical therapist in Portugal three times a week for the last two months. I’ll chalk it up to crushing my fifth vertebrae body surfing in California back in 1990, and I’ll offer a sarcastic “thanks” to a chiropractor who was much too aggressive in adjusting my neck back in Prague.

The cost per PT visit: €7.50, or about $8.15.

I only share that otherwise mundane factoid because of a story that popped up in my news feed last week:

Free healthcare is on the wish list for 70% of expats but where in Europe do they get it?

The research comes from an outfit called Expatsi and is focused on a survey of nearly 43,000 Americans. So, it’s probably representative of something…

The headline got me to thinking about my own experiences with the European medical system when I lived in the Czech Republic from 2018 to last summer, and now that I live in Portugal.

First, let me assure you that healthcare in Europe is quite good to excellent… But it can be frustrating, which I will explain in a moment.

Second, let’s define “free.”

In Portugal, the government-run system is truly free, though you might pay a relatively small amount for certain procedures. And you’ll pay a nominal amount for most prescriptions.

In the Czech Republic, the government-run system is “free”—by and large—when obtaining healthcare at a government-run facility. However, you pay into the system every month through mandatory contributions, much like FICA deductions from a U.S. paycheck. At minimum that’s going to be about $100 to $150 a month—not a lot, but not free.

The real cost of free/quasi-free healthcare in Europe is the wait times. That can range from a day to a couple months, depending on the country. My wife tried to get our son in to see a child psychologist here in Portugal through the state system, and the earliest appointment was more than three months away.

In Prague, wait times were routinely much shorter for most issues, though some issues did necessitate a wait of at least two to three weeks. (Note: The US commentators I see who bash “wait times” in Europe conveniently fail to acknowledge wait times in the US. No American can ring a psychologist or a dermatologist or a cardiologist and immediately get in that day—or even that week.)

What this means is that expats who relocate to Europe very often buy private healthcare insurance.

Those plans vary significantly in price from one country to another, one provider to another.

In Prague, I was paying about €2,300 per year (when I was single) for a plan that gave me access to a series of private clinics populated by English-speaking staff. (Note #2: The state system was also populated by English-speaking staff, as I found out on a weekend when I woke to find my left leg did not want to work as agreed upon and my private clinics were closed.)

When I married my wife and took on responsibility for her son as well, my cost in Prague jumped to about €4,800 per year. But that was all-inclusive, no co-pays. And the facilities were no different than I experienced in the US.

Moving to Portugal has seen a cost savings. I pay about €2,800 for a Cadillac family plan.

But we do have co-pays. They’re not horrible—that €7.50 I pay for my PT appointments, for instance, and up to about €50 for other kinds of appointments.

I mean, it’s all very affordable compared to the US. I paid a grand total of about $82 for a root canal in Prague, and about $112 for a CT scan in Portugal (without insurance).

And the quality of the healthcare you receive in Europe is equally as good, if not better than the US.

My Prague root canal was completed with local anesthesia, then I took the tram back home on my own with no concern. I popped a few Ibalgin (European Ibuprofen) when necessary for any lingering pain.

In Portugal, my initial visit with a general practitioner about my neck issue was surprisingly thorough and time consuming—much more so than I’m accustomed to with the churn-‘em-burn-‘em US medical system.

But there are certain annoyances for sure…

I’m 58 years old. I’ve been running this body my entire life. I kinda know how it works on a certain level. I know, for instance, that when winter turns to spring and summer turns to fall, I’m quite likely to show up with a sinus infection that starts with a scratchy throat and explodes from there. I also know that the only thing that helps is a tanker truck of Afrin nose spray, drug-dealer quantities of Mucinex, and a round of antibiotics.

This is inscribed on the first page of the Jeff Opdyke User Manual.

But go looking for antibiotics in certain parts of Europe and you might as well be chasing the Easter Bunny riding a unicorn up a rainbow.

I don’t think I was prescribed antibiotics in Prague even once. And when I came down with a respiratory infection in Amsterdam last year that caused coughing so violent I was vomiting, a local doctor refused to prescribe antibiotics because “we don’t think it’s good to use them.”

This is why I’ve loaded up on antibiotics from Mexico. (Don’t come at me; one’s gotta do what one knows is right for one’s own body.)

You’re also not typically going to find in Europe some of the over-the-counter meds you’re accustomed to grabbing at Walgreens or CVS. I cannot find Mucinex or Afrin here. Not can I find Delsym cough syrup or BC Powder for headaches, both of which work well for me.

But beyond the annoying anti-antibiotics stance and a dearth of certain OTC meds, I’m happy with European healthcare. The quality is high (very often higher than the US), and the outcomes have been good.

Just know, though, that not everything is “free.” There are very often costs involved. But those costs are still a fraction of what you’re going to pay in the US.

All of this reminds me: I need to book a trip to Mexico soon…