In Singapore we had Mount Elizabeth Hospital ten minutes away, a paediatrician we'd seen since our eldest was born, and a healthcare system that just worked. Then we moved onto a boat and our first medical emergency was one of the kids spiking a fever of 40 degrees on a Tuesday night anchored off a Greek island with no pharmacy and no mobile signal.
That was a steep learning curve.
Healthcare is the thing most families underestimate when they move abroad. Not because they forget about it, but because they assume it'll be roughly the same as home. It won't.
The insurance trap
Most people start with travel insurance. That's fine for a two-week holiday. It's not enough for a family living abroad.
Travel insurance typically won't cover pre-existing conditions, ongoing prescriptions, dental, mental health, or anything that looks like routine care. If your kid needs an inhaler refill or you need a repeat prescription for something you've been taking for years, travel insurance won't touch it.
What you need is international health insurance, sometimes called expat health insurance. It's more expensive but it actually covers the things families use. We started with a travel policy and switched to Cigna Global about six months in. The difference was significant, both in cost (around $600/month for the four of us) and in what was actually covered.
Things to check before you sign up:
- Does it cover the specific countries you'll be in? Some policies exclude the US, which matters if you're transiting or visiting family there
- What's the excess per claim? A high excess usually means small GP visits come out of your own pocket
- Is dental included or an add-on? It's usually an add-on and it's usually worth it with kids
- What about emergency evacuation? If you're somewhere rural this matters a lot
- Can you see any doctor or only ones in their network?
Finding a doctor when you don't speak the language
In Greece and Türkiye we relied heavily on recommendations from other international families and sailing communities. Facebook groups are really useful for this. "Can anyone recommend a paediatrician in Preveza?" posted at 9pm would usually have three answers by morning.
In Portugal and Spain, the public healthcare systems are solid once you're registered. The challenge is getting registered, which usually requires residency paperwork, a fiscal number, and patience. Budget two to four weeks from arrival to having a GP you can actually see.
We also kept a translated medical file for each kid. Their vaccination records, any allergies, previous illnesses, all translated into the local language by translator. Sounds excessive, but when you're in a hospital at 2am trying to explain that your son is allergic to a specific antibiotic, having it written down in Greek would save you some stress!
Prescriptions across borders
This one can catch you out. You think you've packed enough, then plans change. That happened to us with one medication: the brand doesn't exist in Europe, the active ingredient had a different name, and no pharmacist would sell it to us without a local prescription.
Here's what works:
- Get a letter from your current doctor listing every medication by its generic (chemical) name, not the brand name
- Include the dosage and what it's for
- Carry a three-month supply of everything when you first move
- Find a local GP quickly and get prescriptions transferred
For ongoing medications it gets easier once you have a local doctor, but that first month or two can be frustrating.
Vaccinations and school requirements
Different countries require different vaccinations for school entry. Portugal required proof of certain immunisations we'd done in Singapore, but the records were in a format they didn't recognise. We had to get the kids re-tested for antibodies to prove they'd been vaccinated, which cost about 150 euros per child.
Keep your vaccination records in a standard format. The WHO yellow card (International Certificate of Vaccination) is widely recognised and worth having, even if your home country doesn't routinely issue them.
Mental health (the thing nobody talks about)
Moving countries is stressful. Moving countries with kids is really stressful. And the mental health support that exists in one country may not exist in the next.
We didn't think about this before we left. We should have. Emily went through a rough patch in year two, and finding an English-speaking therapist who could do sessions online was harder than it should have been. Services like BetterHelp and Talkspace work internationally, and it's worth setting that up before you need it.
What I'd tell you
Healthcare abroad isn't worse than at home. It's different, and the gap between what you're used to and what you find can be jarring when it's your kid who's sick.
Sort out proper insurance before you go. Carry translated medical files. Stock up on prescriptions. And find a local doctor in your first week, not when you need one at midnight. (It's on our first 90 days checklist for a reason.)
If you're planning a move and want help thinking through the practical stuff like this, book a call. It's the kind of thing we work through in our logistics sessions.
