2026-02-25 · NextMigrate Team
What Healthcare Actually Costs Out of Pocket: A 10-Country Comparison
Here is a question that keeps coming up in professional communities across Lagos, Mumbai, Manila, Cairo, and Karachi: "I earn a decent salary, so why does one hospital visit feel like it could bankrupt me?"
The answer is not complicated. In many developing economies, "affordable healthcare" is a fiction maintained by quoting low sticker prices while ignoring the reality that most people pay for everything out of their own pockets. There is no meaningful safety net. There is no insurance that actually covers what you need. And when something serious happens — a complicated pregnancy, a burst appendix, a child with asthma — you discover very quickly what healthcare actually costs.
This article compares real, out-of-pocket costs for common medical events across ten countries. Not theoretical costs. Not government-subsidized prices that only apply if you can tolerate a six-month wait. The actual amount you will pay from your own bank account when something goes wrong.
The Countries We Are Comparing
We selected five source countries where many professionals live and work, and five destination countries with established healthcare systems:
Source countries: Nigeria, India, Philippines, Egypt, Pakistan
Destination countries: Canada, Australia, United Kingdom, Germany, United Arab Emirates
The goal is not to rank healthcare systems abstractly. It is to answer a practical question: if you or your family member needs medical care, what will it cost you personally?
How Healthcare Spending Breaks Down
Before diving into procedure costs, it helps to understand the broader picture. The percentage of healthcare costs that come directly from your pocket varies enormously by country.
| Country | Out-of-Pocket as % of Total Health Spending | Per Capita Health Spending (USD) | Government Health Spending as % of GDP |
|---|---|---|---|
| Nigeria | 77% | $71 | 0.5% |
| India | 55% | $83 | 1.3% |
| Philippines | 47% | $161 | 1.4% |
| Egypt | 62% | $131 | 1.4% |
| Pakistan | 56% | $46 | 1.2% |
| Canada | 15% | $5,905 | 7.6% |
| Australia | 17% | $5,187 | 6.5% |
| United Kingdom | 17% | $5,138 | 8.0% |
| Germany | 13% | $6,731 | 9.4% |
| UAE | 14% | $2,466 | 3.2% |
Sources: WHO Global Health Expenditure Database, World Bank 2024 data
Look at that first column carefully. In Nigeria, 77 cents of every dollar spent on healthcare comes directly from patients. In Canada, it is 15 cents. This is the fundamental structural difference that no amount of "but healthcare is cheaper in Lagos" can paper over.
Procedure 1: Childbirth
Childbirth is the single most common reason for hospitalization worldwide. It is also the medical event that most clearly exposes the gap between what healthcare is supposed to cost and what it actually costs.
Normal Vaginal Delivery
| Country | Public Hospital Cost (USD) | Private Hospital Cost (USD) | What Insurance Typically Covers |
|---|---|---|---|
| Nigeria | $150 - $400 | $800 - $2,500 | Most employer plans cover 60-80%, but many cap at $500-$1,000 |
| India | $100 - $300 | $500 - $2,000 | Government schemes cover public only; private insurance often excludes maternity for first 2-4 years |
| Philippines | $200 - $500 | $600 - $1,500 | PhilHealth covers roughly $200; rest is out-of-pocket |
| Egypt | $100 - $250 | $500 - $1,800 | Social insurance covers public hospitals; long waits push most to private |
| Pakistan | $80 - $200 | $400 - $1,500 | Very limited insurance penetration; most pay cash |
| Canada | $0 | N/A (birthing centers: $0) | 100% covered by provincial health insurance |
| Australia | $0 | $2,000 - $5,000 (gap after rebate) | Medicare covers public fully; private insurance reduces gap for private |
| United Kingdom | $0 | $5,000 - $15,000 (private choice is rare) | NHS covers 100% |
| Germany | $0 | $0 (statutory insurance covers both) | Statutory insurance covers everything including midwife |
| UAE | $0 - $500 (with mandatory insurance) | $3,000 - $8,000 (depending on plan tier) | Mandatory employer insurance covers most costs |
Cesarean Section
This is where costs escalate dramatically, and where the out-of-pocket burden in developing countries becomes genuinely dangerous.
| Country | Public Hospital (USD) | Private Hospital (USD) | Typical Out-of-Pocket After Insurance |
|---|---|---|---|
| Nigeria | $400 - $800 | $1,500 - $5,000 | $800 - $3,000 |
| India | $300 - $700 | $1,000 - $4,000 | $500 - $2,500 |
| Philippines | $500 - $1,000 | $1,200 - $3,500 | $600 - $2,000 |
| Egypt | $300 - $600 | $800 - $3,000 | $400 - $2,000 |
| Pakistan | $200 - $500 | $600 - $2,500 | $300 - $1,500 |
| Canada | $0 | N/A | $0 |
| Australia | $0 | $3,000 - $7,000 gap | $0 (public) |
| United Kingdom | $0 | Rarely done privately | $0 |
| Germany | $0 | $0 | $0 |
| UAE | $0 - $1,000 | $5,000 - $12,000 | $0 - $2,000 depending on plan |
Now, the sticker prices in Nigeria or Pakistan might look lower than in, say, a private Australian hospital. But context matters. A cesarean section costing $2,500 in Lagos represents roughly three to five months of salary for a mid-level professional earning NGN 8 million per year. The same procedure costing $0 in Toronto represents exactly zero months of salary for anyone.
That is the comparison that actually matters.
Procedure 2: Appendectomy
An appendectomy is the classic emergency surgery. You do not get to plan for it. You do not get to shop around. Your appendix is inflamed and you need it out within hours.
| Country | Average Total Cost (USD) | Typical Out-of-Pocket (USD) | Average Hospital Stay |
|---|---|---|---|
| Nigeria | $500 - $2,000 | $400 - $1,500 | 3-5 days |
| India | $400 - $1,800 | $300 - $1,200 | 2-4 days |
| Philippines | $600 - $2,000 | $400 - $1,200 | 3-5 days |
| Egypt | $400 - $1,500 | $300 - $1,000 | 3-4 days |
| Pakistan | $300 - $1,200 | $200 - $900 | 3-5 days |
| Canada | $5,000 - $12,000 | $0 | 1-2 days |
| Australia | $4,500 - $10,000 | $0 (public); $500 - $2,000 gap (private) | 1-2 days |
| United Kingdom | $5,000 - $9,000 | $0 | 1-2 days |
| Germany | $4,000 - $8,000 | $0 (copay: $11/day hospital fee) | 2-3 days |
| UAE | $4,000 - $9,000 | $0 - $1,500 (depending on insurance tier) | 1-2 days |
Notice something else in that table. Hospital stays in developed countries are shorter. Not because the care is worse, but because the surgical techniques, infection control, and post-operative care are more advanced. Laparoscopic appendectomy is standard in Toronto or Melbourne. In many hospitals across Lagos or Karachi, you are still getting an open procedure with a longer recovery, higher infection risk, and more time away from work.
The hidden cost of that extra recovery time — lost wages, someone else caring for your children, potential complications from a less modern technique — never shows up in any cost comparison.
Procedure 3: Treating a Broken Arm
A straightforward fracture. Not life-threatening, but it needs to be set properly, casted, and followed up.
| Country | ER Visit + X-Ray + Cast (USD) | Follow-Up Visits (USD) | Total Out-of-Pocket (USD) |
|---|---|---|---|
| Nigeria | $100 - $400 | $50 - $150 | $150 - $550 |
| India | $80 - $350 | $30 - $100 | $110 - $450 |
| Philippines | $100 - $400 | $40 - $120 | $140 - $520 |
| Egypt | $80 - $300 | $30 - $100 | $110 - $400 |
| Pakistan | $60 - $250 | $20 - $80 | $80 - $330 |
| Canada | $0 | $0 | $0 |
| Australia | $0 (public) | $0 (public) | $0 (public) |
| United Kingdom | $0 | $0 | $0 |
| Germany | $0 | $0 | $0 |
| UAE | $0 - $200 | $0 - $100 | $0 - $300 |
For a broken arm, the developing country prices genuinely are lower in absolute terms. But again: as a percentage of income, a $400 ER bill in Lagos hits much harder than a $0 bill in London.
And there is a quality dimension. Access to orthopedic specialists, proper imaging equipment, and physiotherapy follow-up varies dramatically. A poorly set fracture can cause lifelong complications. The cheapest treatment is not always the most economical in the long run.
Procedure 4: Annual Diabetes Management
Chronic disease is where out-of-pocket costs truly devastate families in developing countries. It is not one bill — it is an ongoing, permanent drain on household income.
Annual Cost of Managing Type 2 Diabetes
| Country | Medication (USD/year) | Doctor Visits (USD/year) | Lab Tests (USD/year) | Total Annual OOP (USD) |
|---|---|---|---|---|
| Nigeria | $300 - $800 | $100 - $300 | $80 - $200 | $480 - $1,300 |
| India | $200 - $600 | $60 - $200 | $50 - $150 | $310 - $950 |
| Philippines | $250 - $700 | $80 - $250 | $60 - $180 | $390 - $1,130 |
| Egypt | $150 - $500 | $60 - $180 | $40 - $120 | $250 - $800 |
| Pakistan | $150 - $500 | $50 - $150 | $40 - $120 | $240 - $770 |
| Canada | $0 - $300 (some provinces cover all meds) | $0 | $0 | $0 - $300 |
| Australia | $70 - $200 (PBS-subsidized) | $0 (bulk-billed GP) | $0 (Medicare-covered) | $70 - $200 |
| United Kingdom | $0 (prescription exempt for diabetes) | $0 | $0 | $0 |
| Germany | $50 - $150 (copay only) | $0 | $0 | $50 - $150 |
| UAE | $100 - $500 (insurance copay) | $0 - $100 | $0 - $100 | $100 - $700 |
In the UK, diabetes patients pay literally nothing for their medication. It is one of the conditions that qualifies for a medical exemption certificate. Every prescription, every blood test, every GP visit, every specialist referral — zero pounds.
In Nigeria, a person with diabetes on a salary of NGN 500,000 per month (roughly $310) could be spending 15-35% of their gross income just keeping themselves alive. Every single month. For the rest of their life.
This is the arithmetic that does not appear in "cost of living" comparisons.
The Hidden Costs Nobody Talks About
Transportation to Healthcare
In many developing countries, the nearest competent hospital might be hours away. This adds costs that never appear in medical bills:
| Country | Average Distance to Quality Hospital (Urban) | Transportation Cost per Visit | Lost Work Hours per Visit |
|---|---|---|---|
| Nigeria (Lagos) | 5-15 km (but 1-3 hours in traffic) | $5 - $20 | 4-8 hours |
| India (Mumbai) | 3-10 km | $2 - $10 | 3-6 hours |
| Philippines (Manila) | 3-12 km | $3 - $15 | 3-7 hours |
| Pakistan (Karachi) | 5-15 km | $3 - $12 | 4-8 hours |
| Canada (Toronto) | 2-5 km | $3 - $8 (transit) | 1-3 hours |
| Australia (Melbourne) | 2-5 km | $3 - $6 (transit) | 1-2 hours |
| UK (London) | 1-3 km | $2 - $5 (transit) | 1-2 hours |
| Germany (Munich) | 1-4 km | $3 - $6 (transit) | 1-2 hours |
The Generator Tax on Hospitals
This one is specific to countries with unreliable power. In Nigeria, hospitals run generators for an average of 8-14 hours per day. That diesel cost gets passed to patients. A private hospital in Lagos might spend $15,000-$30,000 per month on diesel alone. That cost is embedded in every bill you receive.
You are paying for electricity twice: once through your utility bill, and once through inflated hospital charges.
Medication Quality and Availability
The WHO estimates that up to 10% of medical products in low and middle-income countries are substandard or falsified. In parts of West Africa, that figure may be as high as 19% for antimalarial drugs. This means you might pay for medication that does not work, requiring repeat visits and repeat purchases.
In countries like Canada, Australia, the UK, and Germany, pharmaceutical regulation is rigorous. You pay once for medication that works.
What About Health Insurance?
Insurance Penetration Rates
| Country | Population with Health Insurance (%) | Quality of Coverage |
|---|---|---|
| Nigeria | ~3% (private); NHIS covers ~5% formally | Very limited; many exclusions, low caps |
| India | ~37% (Ayushman Bharat + private) | Government scheme covers hospitalization only; private varies widely |
| Philippines | ~92% (PhilHealth enrollment) | Covers partial costs only; large gaps remain |
| Egypt | ~58% (social insurance) | Covers public facilities; quality drives people to private |
| Pakistan | ~5% (Sehat Sahulat expanding) | Government scheme is limited; private insurance is rare |
| Canada | 100% (provincial) | Comprehensive for hospital and physician; gaps in dental, vision, prescriptions |
| Australia | 100% (Medicare) | Comprehensive; private insurance supplements for faster access |
| United Kingdom | 100% (NHS) | Comprehensive including prescriptions (small copay or exempt) |
| Germany | ~99.9% (statutory + private) | Comprehensive including dental, vision, prescriptions |
| UAE | ~99% (mandatory employer-provided) | Varies by plan tier; basic plans have significant copays |
Having insurance on paper is very different from having insurance that works. PhilHealth coverage in the Philippines looks impressive at 92%, but the actual reimbursement amounts are so low that patients still pay the majority of costs themselves. India's Ayushman Bharat scheme covers hospitalization up to INR 500,000 ($6,000) per family per year — which sounds reasonable until you realize it does not cover outpatient care, diagnostics, or medication outside of hospital stays.
The Catastrophic Health Expenditure Problem
The World Health Organization defines "catastrophic health expenditure" as spending more than 10% of household income on healthcare. Here is how each country performs:
| Country | % of Households Facing Catastrophic Health Spending | People Pushed into Poverty by Healthcare Costs (millions/year) |
|---|---|---|
| Nigeria | 25.5% | 11.4 |
| India | 17.9% | 55.0 |
| Philippines | 7.1% | 1.5 |
| Egypt | 9.8% | 2.1 |
| Pakistan | 12.6% | 6.3 |
| Canada | 1.4% | Negligible |
| Australia | 1.8% | Negligible |
| United Kingdom | 1.2% | Negligible |
| Germany | 0.8% | Negligible |
| UAE | 0.5% | Negligible |
In Nigeria, one in four households is being financially devastated by healthcare costs in any given year. In Germany, it is less than one in a hundred.
This is not a quality-of-life difference. It is a structural risk to your family's financial survival.
The Real Comparison: Healthcare Cost as a Percentage of Income
This is the table that matters most. We are comparing the annual out-of-pocket healthcare spending for a family of four as a percentage of the average professional salary in each country.
| Country | Average Professional Salary (USD) | Estimated Annual OOP Healthcare (USD) | Healthcare as % of Salary |
|---|---|---|---|
| Nigeria | $5,000 - $10,000 | $800 - $2,500 | 16% - 25% |
| India | $6,000 - $14,000 | $500 - $1,800 | 8% - 13% |
| Philippines | $5,000 - $12,000 | $600 - $1,500 | 7% - 12% |
| Egypt | $4,000 - $10,000 | $400 - $1,200 | 6% - 12% |
| Pakistan | $3,500 - $8,000 | $400 - $1,200 | 8% - 15% |
| Canada | $45,000 - $75,000 | $500 - $1,500 (dental, vision, prescriptions) | 1% - 2% |
| Australia | $50,000 - $80,000 | $400 - $1,200 | 0.8% - 1.5% |
| United Kingdom | $40,000 - $70,000 | $200 - $600 | 0.3% - 0.9% |
| Germany | $45,000 - $75,000 | $300 - $800 | 0.4% - 1.1% |
| UAE | $40,000 - $70,000 | $300 - $1,500 | 0.7% - 2.1% |
A Nigerian professional might spend 20% or more of their income just keeping their family healthy. A British professional with the same qualifications spends less than 1%. That gap — 19 percentage points of your salary — is money that could go toward savings, education, investment, retirement, or simply living a less stressful life.
What This Means For Your Family's Future
Healthcare costs are not just a line item in a budget. They are a risk multiplier. When you live in a country where a single serious illness can cost several months of salary, every aspect of your financial planning is distorted. You cannot save as aggressively because you need a medical emergency fund. You cannot invest as freely because liquidity matters more. You cannot take career risks because losing employer-provided insurance — however inadequate — is terrifying.
In countries with universal healthcare systems, that risk largely disappears. A cancer diagnosis in Canada is devastating emotionally but not financially. A complicated pregnancy in Germany does not require selling assets. A child's broken bone in the UK does not trigger a GoFundMe campaign.
The professionals who understand this arithmetic are not comparing healthcare costs in dollar terms. They are comparing healthcare costs in terms of financial security, career flexibility, and peace of mind.
When you spend 20% of your income on healthcare in Lagos, you are not just paying for medical services. You are paying a tax on living in a system that does not protect you. And unlike actual taxes, this one buys you nothing in return except the right to keep paying it next year.
The question worth asking is not "where is healthcare cheapest?" It is "where does healthcare stop being something I have to worry about?"
For millions of professionals across Nigeria, India, the Philippines, Egypt, and Pakistan, that question is becoming impossible to ignore.
