Beyond the Welcome Mat: Why European Host Countries Must Address Hidden Expat Challenges
Relocation often comes with promise—new careers, fresh experiences, and cultural adventures. Yet, behind that bright façade lies the day-to-day challenges that many expats don’t see until they arrive. From housing and schools to banking and bureaucracy, expatriates quickly learn that adapting involves far more than finding a job or a place to live. When these underlying struggles remain unaddressed, they place undue pressure on both families and the very systems designed to serve them—most notably, healthcare.
A Broader View Across Europe
Spain
Spain’s sunny climate, universal healthcare, and vibrant cities attract thousands of expats annually. But differences in regional procedures and long wait times for specialists can leave newcomers frustrated. Many discover that registering for public healthcare—while theoretically simple—varies from Madrid to Barcelona, and that private insurance becomes a necessity for timely care.
Portugal
With its affordable lifestyle and growing digital-nomad hubs, Portugal ranks high on many expat wish lists. Still, long waits for routine medical appointments and the requirement to learn Portuguese to fully navigate public services create unexpected hurdles. Even commonplace tasks like scheduling a check-up or understanding copay rules can consume precious time.
Italy
Italy’s allure—its food, history, and “dolce vita”—masks the complexities of its healthcare system, where local health offices (ASLs) manage insurance enrollment and family doctors act as strict gatekeepers to specialists. What seems like a short drive to a “medico di base” can quickly turn into weeks of paperwork and referrals, especially for those who arrive without local connections.
France
France’s global reputation for high-quality medicine and a strong social safety net makes it an expat favorite. Yet nearly every newcomer discovers that obtaining a “Carte Vitale,” choosing a primary “médecin traitant,” and securing a supplemental “mutuelle” can feel like running a bureaucratic gauntlet. Even small misunderstandings around reimbursement rules can lead to costly surprises.
Focus on The Netherlands: A Unique Expat Landscape
Among these top destinations, the Netherlands often ranks near the top for overall expat satisfaction. Its English-friendly environment, strong preventive focus, and high quality of life are major draws. Still, Dutch systems harbor their own subtle challenges:
Mandatory Private Insurance Within four months of registering at your local gemeente, expats must purchase a private “basisverzekering.” Premiums hover around €130 per person each month, and families often pay €260–€390. Missing this window can mean a fine of about €400 plus retroactive premiums—an unwelcome expense for someone still unpacking boxes.
Annual Deductible (“Eigen Risico”) Dutch residents pay the first €385 (roughly $420) of most non-GP expenses each year. While GP visits, maternity, and preventive care are exempt, every lab test, specialist consult, and prescription hits that deductible. For families juggling school registrations, housing searches, and new jobs, this out-of-pocket requirement can be a significant budget item.
GP as the Gatekeeper To see a specialist—dermatologist, orthopedist, or cardiologist—expats need a referral from their huisarts (family doctor). In busy urban practices, finding an available GP can take weeks, and each appointment typically lasts only ten minutes. That limited time forces expats to triage what to discuss, often sidelining less urgent but important concerns.
Bureaucracy & Subsidies Beyond insurance, expats navigate the Dutch tax system to apply for zorgtoeslag (healthcare allowance), which can reduce premiums by up to €127 monthly for lower-income households. Yet the application process—requiring Dutch income estimates and annual updates—adds another layer of complexity that newcomers must juggle alongside their new routines.
System Strains Though the Netherlands has many doctors, a reported 3–4% GP vacancy rate in 2024 means some practices struggle to accommodate new patients. As a result, expats sometimes default to emergency departments for non-urgent issues, inadvertently placing extra strain on hospitals already coping with seasonal peaks.
A Path Forward: Co-Creating Solutions with Expats
Across popular expat destinations in Europe such as Spain, Portugal, Italy, France, and the Netherlands, common themes emerge: limited English‐language resources, unpredictable appointment waits, and opaque reimbursement processes. These gaps not only frustrate expats but ripple out to strain public systems. When families delay routine care, rely on emergency services, or even seek care for concerns that may only require advice or reassurance, everyone pays a price—longer wait times, higher costs, and diminished trust in institutions.
The most effective remedy isn’t merely increased funding or more clinics. It’s involving expats—those who live these challenges—in designing solutions. By creating Expat Advisory Councils, hosting “healthcare orientation” workshops in multiple languages, launching easy-to-use digital guides (video walk-throughs, simple checklists), and utilizing available expat services designed to help, host countries can transform hidden pain points into opportunities for collaboration.
Expat Voices: Monthly forums where newcomers share firsthand hurdles—whether “How do I book a GP in English?” or “What does my ‘eigen risico’ actually cover?”
Multilingual Tools: Step-by-step videos showing how to register with local authorities, enroll in insurance, or schedule appointments without confusion.
Real-Time Feedback: Quick post-visit surveys to capture whether information was clear, interpreters were available, or the process felt transparent.
Expat Services: Leverage existing support networks—relocation companies, patient navigators, concierge services, and community organizations—to connect expats with on-the-ground help and accelerate their adaptation.
When expat insights help shape public services, the result is a system that scales gracefully, serving a broader population with fewer missteps. Ultimately, engaging expats creates healthier, more resilient communities, and alleviates pressure on systems and the negative sentiment that can build among the locals as a result of that—benefiting both the newcomers and the host nation.
RJ Pesigan is the founder and owner of Cornerstone Health, created to address the multifaceted healthcare needs of expats in the Netherlands. Trained in Internal Medicine and Sport & Exercise Medicine, RJ has worked in both resource-limited and advanced clinical environments—from busy hospital wards treating critically ill patients to performance-focused sports clinics guiding athletes to peak health. Through Cornerstone Health, RJ leverages clinical expertise and real-world expat insight to help families and professionals navigate the Dutch healthcare system with confidence, clarity, and peace of mind.
Original article: https://www.linkedin.com/pulse/beyond-welcome-mat-why-european-host-countries-must-pesigan-md-mba-lenhe/?trackingId=fRHb72tmT%2Bam%2BDTZicCITg%3D%3D