High Healthcare Costs Are Pushing Wealthy Americans to Look Abroad

Healthcare concerns are driving almost half of wealthy Americans considering a second residency, according to La Vida’s 2026 US Investment Migration survey.

47.1% of respondents cited healthcare as a concern, up from 39.1% in La Vida’s 2025 US survey. That is more than double the 21.7% of UK investors who said the same in La Vida’s 2026 UK survey.

It’s a shift our advisers have noticed in conversations with American clients this year. Many start by talking about politics, but healthcare and the cost of everyday life come up within the first few minutes.

Cost of Living Climbs Alongside Healthcare

Cost of living rose even faster than healthcare. 51.4% of respondents cited it this year, up from 35.9% in 2025.

The two concerns often go together. For many American families, the cost of healthcare is one of the biggest parts of the household budget, and it shapes how they feel about everything else.

“A lot of our social liberties are taken away that remain in Europe. Crime is way too high. Cost of living is much higher here than in Europe. Housing, food, and household items are much more expensive here compared to Europe,” said one respondent.

“The food in the US has become very unhealthy and not properly regulated,” said another.

Comments like these come up regularly in our conversations with US clients. Many aren’t only looking for a safer political environment. They want a healthier, more affordable way of life for their families.

Why Europe Appeals to American Families

Europe stood out as the clear favourite destination. Portugal led at 63.6% of respondents, followed by Italy at 27.3% and Greece at 21.2%.

Much of that appeal comes down to quality of life. European countries offer well-regarded public health systems, and private health insurance often costs considerably less than comparable cover in the US.

“Quality of life in Greece is much higher than in the US,” said one respondent.

The data backs that up. The WHO and World Bank’s Universal Health Coverage Service Coverage Index, which measures access to essential health services across 195 countries, gave Portugal a score of 83 out of 100 in 2023 and Malta 82, placing both in the top fifth of countries measured. Greece scored 77, comfortably above the global average of 71.

Closer to home, Panama offers a practical alternative for American families, and 13.6% of respondents named it as a destination they would consider. Panama City is a short direct flight from Miami, Houston and New York, the country uses the US dollar, and Hospital Punta Pacifica is affiliated with Johns Hopkins Medicine International. Private healthcare in Panama can cost up to 60% less than in the US, with a knee replacement typically costing $12,000 to $18,000, compared with $35,000 to $55,000 at home.

Healthcare and Residency Programs Compared

Healthcare access varies by program, so it’s worth understanding what each route offers before choosing one.

Portugal suits American families who want EU residency with very little time commitment, plus access to a national health system once they register as residents. Malta appeals to those who want to settle in an English-speaking country with permanent residence from the outset.

A Plan B Built Around Wellbeing

A Plan B was the top goal among US respondents, named by 84.3%, up from 76.4% in 2025.

For many of our American clients, a second residency is about more than politics. It’s about knowing their family could access a different way of life, with more affordable living costs and a healthcare system they trust, if they ever decide to make the move.

Golden Visa programs in Portugal, Greece and Malta offer American families EU residency, each with its own requirements and timelines. Our advisers are always happy to talk through what might suit your circumstances, with no obligation.

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