In Simple Terms
An American woman moved to Malta because health care in the United States had become too expensive, even with insurance. In Malta, a small weekly payment covers much of her care, but public appointments can take time, paperwork is common, and some newer medicines are hard to get. Her experience shows that cheaper care can bring peace of mind, but not always speed or choice.
A decision made by the bills, not the doctors
Moving to Malta was not simply a lifestyle choice. For years, the writer had been treated for several serious health problems, including multiple sclerosis, diagnosed in 2002, breast cancer, the removal of part of her liver, and an injury that broke her leg in three places. Through all of it, the cost of care in the United States remained a constant concern—even when she had good insurance through her husband’s employer.
Her insurance plan charged $40 for a doctor’s visit, and the family’s annual out-of-pocket maximum was $6,000. But the total annual cost of the insurance was $26,888. Her husband paid $9,988, with his employer covering the rest. Even so, she came close to reaching the out-of-pocket maximum nearly every year. Specialist care and ongoing medication meant that good insurance softened some of the costs, but did not make them disappear.
When her husband considered leaving his government job to become a consultant, the couple would have had to buy insurance on the individual market. They estimated that a mid-level plan in New York would cost about $30,000 a year once premiums and deductibles were included. Those were their estimates for 2026, a year when marketplace premiums rose by an average of 26%. UnitedHealthcare sought a 52% increase in New York for 2027 coverage. According to the writer, open enrollment for 2027 coverage ran from November 1 to December 15, a shorter window than usual.
For a family about to move from two incomes to one, these figures were no abstraction. The writer found a possible route to Malta through the European Union passport she had inherited from her mother. It allowed her to live on the island and use its health system. She emphasizes that this option is not available to most Americans and is not an easy-to-copy plan; her family circumstances gave her a path many others do not have.
A small contribution, and a lot less worry
In Malta, she pays €38 a week in social security contributions, or about €2,300 a year by her calculation. This covers care and medication, including a drug she estimates would cost about $80,000 a year in the United States. She also says that hospital stays and emergency responses—including helicopter rescues—do not result in a patient bill under the public system.
She noticed that some of the barriers she had faced in the United States were absent. She did not have to wait for an insurance company’s prior approval before receiving a service, nor was she required to try a cheaper drug before another treatment could be considered. She also stopped receiving repeated letters questioning whether her treatment qualified for coverage because of a secondary insurance policy she did not have—a problem that had come up every year in her American experience.
That does not mean administrative work has vanished everywhere. In the United States, a 2025 survey by the American Medical Association found that doctors handled an average of 40 prior-authorization requests each week, while clinics devoted 13 hours a week to completing them. Some 40% of doctors employed staff to follow up with insurance companies, and about three-quarters said coverage denials had increased over the five years before the survey. These figures help explain why getting approval for treatment can be part of a doctor’s routine workload, not just a one-off task for a patient.
The writer does not portray Malta as a system where no one ever pays. Payment is part of the picture, but it works differently: a social contribution funds access to public care, while people who want a faster private appointment can pay directly. That is the central distinction in her account. The comparison is not between care that is completely free and care that is entirely paid for out of pocket; it is between different ways of distributing costs, waiting times, and choices.
Where the pharmacy can double as a clinic
The health-care landscape she describes has two tracks: a public system that guarantees care and a private sector that offers speed and flexibility to those who can afford it. A visit to a general practitioner at a private clinic inside a pharmacy costs €15 to €20, while a specialist visit is about €70. Someone who wants a quick ultrasound might pay €120. In the writer’s case, the scan was performed by a doctor specializing in breast-cancer imaging, who explained the result during the same appointment.
More than 200 licensed pharmacies operate in Malta, and some have small rooms for medical examinations and consultations. These locations may not look like large clinics with reception desks and billing systems. A patient might see a doctor in a side room and then pay at the pharmacy counter. Many specialists work in both the public and private sectors, seeing patients at a hospital for part of the week and at different pharmacies on other days.
The writer says her neurologist works one day a week at a hospital and four days at four different pharmacies. Patients can choose the location closest to home, work, or places they regularly visit. Other specialists use the same spaces at different times. At one pharmacy she visits, a neurologist sees patients on Tuesday mornings alongside a gynecologist, a kidney specialist, and an eye doctor; the lineup is different the next day.
This model can reduce some of the overhead involved in running a traditional clinic, but bringing the doctor closer to the patient does not solve every problem. Private visits are relatively easy to arrange for people who can pay, while the speed of public care still depends on appointment availability. Having two sectors, then, does not mean everyone gets the same service at the same speed. It gives an additional option to those able to afford it.
Public appointments can mean waiting—and paperwork
When the writer needed specialist follow-up, she first tried the public route. Her general practitioner requested a referral, and she was told that an appointment card would arrive by mail in about two weeks and that the appointment date on it could not be changed. She waited, then called and learned that the relevant office was still looking for a suitable time. In the end, she chose a private appointment rather than face more uncertainty.
Her experience with an oncologist showed what the private route could offer. She called a clinic where a doctor who had led the oncology department at Mater Dei Hospital for 17 years worked. The clinic called her the next day to arrange an appointment two weeks later. The doctor reviewed more than 100 pages of her medical records and ordered hormone tests to consider whether she should switch from tamoxifen to an aromatase inhibitor. He also referred her for an ultrasound with a paper letter.
The medical steps were familiar, but the way they were handled felt different from the digital records and online portals she had relied on before. To receive her medication free through the pharmacy-of-your-choice program, she had to prove that she had paid her social security contributions. There was no central record that automatically confirmed this. She emailed scanned documents and received a reply acknowledging them, but no timeline for completing the process.
Three weeks later, she called and discovered that the form had been mailed and might have been lost. She was told another copy would arrive within 10 business days, but she managed to collect it herself from the office, which was open until 1 p.m. The round trip took 32 minutes in heavy traffic. The experience highlighted two different kinds of paperwork. In the United States, much of it had been about persuading an insurance company that treatment was warranted. In Malta, the forms and proofs were part of administrative procedures rather than being about denying her medical care.
Covering treatment does not guarantee every drug will be available
The writer’s biggest reservations are not just about appointment speed but also about the range of treatment options. She worries that if her cancer returns, Malta may not offer everything she could access in the United States. She says the medical care is good, but a small country may have fewer options and less specialized expertise than a larger one, particularly for new or highly specialized treatments.
The issue is especially clear in multiple sclerosis. More drugs for the condition are available in the United States, but one medicine developed for the writer’s form of the disease is not readily available in Malta. According to the article, the drug is called tolebrutinib and is sold under the name Cenrifki. The U.S. Food and Drug Administration rejected it over concerns about serious liver harm and questions about its effectiveness, while the European regulator approved it in June. It was described as the first treatment shown to slow the worsening of disability in people with nonrelapsing secondary progressive multiple sclerosis—the form the writer has.
European approval, however, does not mean a medicine will automatically reach every member state. Malta has relatively few patients, which may not be enough to encourage the drug’s rapid introduction. The writer notes that the number of people with multiple sclerosis in the United States is close to 1 million—more than the entire population of Malta. The comparison shows how market size and the number of potential patients can affect whether a drug becomes available, even after it receives approval at the European level.
This is a trade-off that the phrase free health care cannot capture. Public coverage can protect patients from costs they could not afford, but it cannot guarantee that every drug, device, or treatment option is available in the system. Decisions about what is provided in a resource-limited system may also leave patients with less say over the details. When the writer discussed a simple procedure that would require an overnight hospital stay to implant a device that delivers medication to the spinal cord, she was told she could not choose the device’s size because the treatment was publicly funded. To her, it was a reminder that financial protection can sometimes come with less flexibility.
A comparison that cannot be reduced to “better”
The writer’s experience offers a mixed picture of the two systems, not a final verdict that applies to every patient. In the United States, she received care from prominent specialists and benefited from access to highly experienced doctors and hospitals. But she also faced substantial out-of-pocket costs, repeated authorization requests, and the fear that her insurance situation would change if her husband left his job. In Malta, the family’s contribution fell to €38 a week, and hospital bills and recurring worries about insurance denials disappeared. Yet public waiting times, paperwork, and uneven access to treatments remained.
Figures on life expectancy and health-care costs also need to be interpreted cautiously. The writer reports that health spending per person in Malta is about one-quarter of U.S. spending and that life expectancy is five years higher. She also notes that Malta has the highest adult obesity rate in the European Union, a warning against reducing population health to a single diet pattern or spending figure. These comparisons do not prove that one particular health system caused the difference. They put broad indicators alongside a personal account, and each has its own context and other contributing factors.
Nor is a fast path through the U.S. system equally available to everyone. A friend of the writer went from experiencing hip pain to receiving an abnormal X-ray result and then having hip-replacement surgery in less than 10 weeks—but she had excellent insurance. Someone without insurance may face not only a long wait, but an inability to get treatment at all. Comparing a quick appointment in one country with a delayed one in another is not enough unless we also ask who can access that route and who pays for it.
The Bottom Line
The move to Malta shows that health care cannot be measured by the price of a drug or the speed of an appointment alone. A contribution of €38 a week gave the writer broad coverage, including a medicine estimated to cost $80,000 a year in the United States, and helped keep hospital bills and insurance denials out of her daily life. In return, she encountered slower public appointments, paper-based procedures, and limits on access to specialized drugs. Private visits offered a faster alternative for direct payment.
The larger lesson is that a guarantee of treatment is not a guarantee of every treatment at every moment, and lower spending does not erase limits on capacity or choice. Nor is the experience of a woman with a European passport a relocation plan everyone can follow. But her story makes the comparison more grounded: every system carries financial, administrative, and human costs. The question is not which one is perfect, but how each distributes the burden of illness—and who can reach the care they need when they need it.