The world’s millionaires and billionaires are increasingly on the move—and private health care costs are playing a growing role in where they choose to live, a new report finds.
New client data released Monday by investment migration consulting firm Henley & Partners shows that international wealth migration reached record levels in 2025, with applications for residence and citizenship programs coming from 92 nationalities.
During the first three quarters of the year, Henley & Partners reported a 43% surge in demand for overseas relocation planning among affluent families compared with the same period in 2024—with health care costs emerging as a key “hidden variable” shaping migration choices of global jet setters.
“As clients build lives across multiple jurisdictions, they are scrutinizing not only access to residence and citizenship, but also the real cost of sustaining that lifestyle—especially the price of reliable private health care,” says Henley & Partners Chairman Dr. Christian H. Kaelin. “Destinations that look attractive on paper can become far less so once true health care exposure is understood.”
The Henley & Partners report cites the new SIP Health Cost Index 2025 released by SIP Medical Family Office, the Swiss-based preventive medicine and health management advisory firm, billed as the only comprehensive assessment of the real cost of private health care across the top 50 countries for wealthy expats.
According to the index, the U.S. ranks as the most expensive private health care market in the world, with average annual International Private Medical Insurance premiums around $18,000 per person.
Hong Kong is a close second, with average insurance premiums exceeding $16,100 annually, followed by Singapore, at over $14,200 per person.
Beyond these traditional high-priced hubs, Asian countries with previously affordable private health care sectors—including China, Thailand, and Taiwan, now rank among the world’s top 12 priciest global markets, driven by surging demand for top-notch hospitals and regional medical tourism.
The report notes that these shifts are “creating budget surprises for relocating families” and factoring heavily into their migration planning.
Europe presents a mixed bag when it comes to private-care expenses, with the U.K., Greece, and Spain ranking among the region’s most expensive markets. On the other side of the spectrum, Romania stands out as one of the most affordable European destinations as related to health care.
Globally, Africa and much of Latin America are the most cost-effective, with Morocco boasting the world’s lowest-cost private health care at $6,251 per year.
Other destinations balancing affordability and quality care in the region include Nigeria, Egypt, Kenya, and South Africa.
“Private health care costs are rising worldwide, but the pace and pattern differ dramatically,” says SIP Medical Family Office CEO Kevin Buerchler. “Two-tier health care systems where the highest-quality care is often accessible only to those who can afford it and are well insured, is increasing.”
Why is that important? Analysts at Henley & Partners maintain that health care costs can make a big difference in whether a location is going to be budget-friendly or suitable in the long run, especially for families with children, for aging parents, or for those seeking elective medical procedures abroad.
“Only in a handful of health care excellence hubs we see the kind of quality and accessibility needed for global families, which makes navigating quality and cost of care more important than ever,” notes Buerchler.
U.S. millionaires are increasingly looking abroad
Basil Mohr-Elzeki, managing partner of Henley & Partners North America, says that high-net-worth Americans have been seeking residences and citizenships in foreign countries at an accelerated pace in the last five years, driven by a variety of reasons, including hedging against geopolitical risk, legacy planning, health care, and education.
“With regards to health care, it is certainly a concern given the high medical costs in the United States,” Mohr-Elzeki tells Realtor.com®,” adding that many of Henley & Partners’ clients pursue citizenship or residence in European Union countries in part because they can access emergency health care and benefit from significantly lower private-care costs than in the U.S.
“Another trend we are seeing is medical tourism in Latin America, particularly Costa Rica and Panama in the private sector,” says Mohr-Elzeki. “Costa Rica particularly is attractive, as access to the public system can be obtained simply by becoming a resident.”
World’s millionaires shun U.S. health care
Meanwhile, the world’s millionaires and billionaires are increasingly hesitant to move to the U.S., avoiding American health insurance and private medical care, according to Buerchler.
“About a decade ago, it was common for clients to insist that their international health insurance includes cover for elective medical treatment in the USA,” Buerchler tells Realtor.com. “At the time, the USA was seen to provide the world’s top medical care, and having it covered by their policy was a priority.”
But now, the demand for U.S. health care “has nearly vanished,” stresses the SIP Medical Family Office CEO.
The firm’s deep-pocketed foreign clients no longer request American health insurance coverage.
“In fact, many clients ask to remove the USA from the area of cover from their policies due to the extremely high cost, but also because the United States is no longer viewed as an attractive health care destination,” adds Buerchler.