New research from APRIL International reveals that cost, inadequate reimbursement and confusion about healthcare systems are preventing expats from accessing care - even when they have health insurance.

An overwhelming 93% of expatriates surveyed stated that they have health cover, yet more than half (53%) have delayed or forgone care that they needed, according to the 2026 Expat Health Barometer, concluded in partnership with Expat Communication and Caisse des Français de l’Étranger (CFE).

Based on responses from more than 6,400 expatriates living in over 80 countries, the findings reveal a significant gap between having health insurance and feeling genuinely protected abroad.

The latest findings from AXA Global Healthcare's World of Work series highlight where organisations can focus their efforts to close the gap between how they support assignees, and the experience reported by people they send abroad.

The third edition in the World of Work series draws on insights from 689 HR decision-makers and 641 non-native assignees across ten markets, examining what is needed for organisations to keep internationally mobile employees performing their best on assignment. As the expectations of assignees continue to evolve, with demand for personalised, flexible support growing alongside shifting motivations for taking placements, the in-assignment period has become the most complex and consequential stage of the assignment journey.

Global mobility is no longer defined by long‑term expatriation. It is defined by movement—shorter assignments, frequent cross‑border travel, hybrid roles, and employees operating across multiple jurisdictions in rapid succession. While workforce strategies have evolved to reflect this reality, medical coverage frameworks have often lagged.

Research from Deloitte and Mercer confirms what mobility leaders already experience: globally mobile populations are becoming more diverse, less predictable, and harder to categorize. Traditional distinctions between “business traveler” and “expatriate” are increasingly artificial, particularly as hybrid work models and extended travel blur the boundaries between temporary presence and residence.

The Cigna Healthcare 2026 International Health Study explores the unique well-being and productivity of individuals working outside their home countries. This report introduces the Evernorth Vitality Index, a metric used to compare the physical, emotional, and social health of the globally mobile workforce against the general population. Findings indicate that while these employees possess a distinct vitality advantage, they simultaneously face acute stressors such as loneliness, financial strain, and healthcare barriers. To maintain this performance edge, the research suggests that organizations must prioritize pre-move support and simplified access to medical care. By fostering a sense of belonging and resilience, employers can fully unlock the professional potential of their international talent. Strategic recommendations focus on utilizing digital health solutions and community-building initiatives to bridge existing support gaps.

By Karim Idilby, Chief Growth Officer, AXA Global Healthcare 

Throughout 2025, approximately 142,000 millionaires chose to relocate to another country, with projections suggesting this could rise to 165,000 in 2026, marking the largest voluntary transfer of private wealth in modern history. In particular, the UK saw its largest-ever exodus last year losing 16,500 millionaires, representing the steepest net loss of any country worldwide. 

The UK provides a clear example of how domestic policy shifts and foreign incentives can reshape the mobility patterns of high-net-worth individuals (HNWIs). Between 2024 and 2025, the UK government abolished the non-domicile tax regime (April 2025), increased capital gains and inheritance tax rates (October 2024), and closed the Tier 1 Investor Visa route. For globally mobile individuals seeking to preserve wealth and optimise investment returns, these policy shifts have fundamentally altered the UK's attractiveness. 

In this iPMI Global article we outline a dramatic transformation in the international medical insurance industry as it adapts to heightened geopolitical instability in the Middle East. By 2026, providers have shifted from passive coverage to dynamic intervention, incorporating autonomous clinical authorizations and localized "Red-Pricing" models to manage war-related risks. Duty of Care obligations for corporations have expanded significantly, now requiring comprehensive safety nets that include psychological trauma support, secure evacuations, and "shelter-in-place" protocols.

The deteriorating stability of the "Dubai Dream" in 2026 as regional military conflicts and missile threats shatter the city's reputation as a safe haven. This shift from an insulated metropolis to a strategic target has forced a radical reassessment of the risks associated with long-term residency for the global elite. Beyond physical security concerns, the passage highlights a regulatory transition involving new taxes and rising costs that further complicate the traditional expatriate lifestyle. Consequently, the international insurance and healthcare sectors are pivoting toward crisis management and specialized coverage for war-related risks. While the city remains a magnet for some, the narrative suggests a market bifurcation where Western talent is increasingly replaced by those fleeing even more volatile regions. Ultimately, Dubai is characterized as transitioning into a high-risk, high-reward environment that requires a more sober calculation of physical and financial safety.

Across Europe, access to outpatient healthcare remains one of the most persistent challenges in private and travel insurance, particularly for expatriates navigating unfamiliar and fragmented healthcare systems. What should be a straightforward medical visit often becomes complex, slow, and difficult to coordinate, creating frustration for patients and inefficiency across the insurance value chain.

This iPMI report presents a comprehensive 2025 overview detailing the mandatory health insurance requirements for expatriates seeking long-stay visas and residency permits worldwide. This strict enforcement primarily exists to ensure that incoming foreigners can cover their own medical expenses, thereby avoiding the overburdening of local public health systems. The article emphasizes that short-term travel insurance is inadequate, noting that governments require policies that are comprehensive and long-term, covering essentials such as hospitalization, emergency care, and repatriation for the entire visa duration. Extensive regional examples show stringent compliance, particularly in the Schengen Area and the Gulf Region. Finally, the article provides practical advice, urging expats to confirm specific visa rules, avoid high deductibles, and ascertain whether the host country requires a local insurer.

The Growing Need for Global Health Coverage for Expats

In a world where career and lifestyle opportunities increasingly transcend borders, more professionals and families are choosing to live and work abroad. According to Finaccord, there were around 66.2 million expatriates in 2017, growing at nearly 6% annually. Broader data from the United Nations suggests that as of 2024, there are over 300 million people living outside their birth country, accounting for 3.6% of the global population.

Behind these figures is a booming market: the expatriate health insurance industry—valued between USD 17 billion and USD 25 billion in 2024—is projected to reach USD 65–75 billion by 2035. This growth is driven by international mobility, rising healthcare costs, and the increasing importance of health security abroad.