With debate about healthcare reform raging across the Atlantic, Reuters asked a selection of expatriates what they thought of healthcare systems at home and abroad.

PIA BRINKMANN - London

Pia Brinkmann is a 42-year-old German who has been living in London and working as a nurse in National Health Service hospitals for the past 18 months. She worked as a nurse in Duesseldorf, Germany, before moving to Britain. What I find positive here in Britain is that there's only one NHS. In Germany there are so many different systems to choose from that the system has become very expensive.

But one of the main things that comes to mind is the cleanliness. Hygiene is much, much better in Germany. And it's not just a lack of money (in Britain) -- it's the whole attitude of the system. Here in London when you come into hospitals you sometimes still find carpets on the floors and people who don't wash their hands.

So, if I really had to choose between the British and the German system I would go for the German system, simply because it seems to take the whole area of health more seriously. Cleanliness and attitudes to hygiene are a big factor for me.

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COLIN WILSON - Paris

Colin Wilson, 52, is a British executive who has lived in Paris for more than a decade, working as a brand director for an international company. He and his British wife have twin daughters aged 7.

I certainly prefer the French system.

What is good here is that if you need specialist help, it is very easy to get access to it, whereas in Britain you have to jump through all sorts of hoops to get your general practitioner to sign off on a referral.

The French system, of course, costs quite a bit of money. There are some fears that France might start to go more in the British direction, with limits on access, which nobody thinks is a good idea.

American health coverage, if you can afford it, is fantastic but it's so expensive that the likelihood is you may not be able to.

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ALEXANDRA VINOCUR - Munich

Alexandra Vinocur is a 38-year-old American who has lived in Germany for the past 15 years. She works for a German TV company in Munich, where she lives with her 2-year-old daughter and German husband.

In Germany there is both private health insurance and public health insurance. I have the public insurance -- and I have to say I have been very happy so far and have felt very well taken care of.

The thing with America is that as long as you are employed, you are fine, but when you get into a situation where you lose your job, then you're in trouble. That's not the case here in Germany. Here your cover continues.
A good example of the difference for me is that I had therapy for a couple of years, and the public medical insurance covered it. That would be unheard of in America. Here it seems that if you have a need, then it will be covered.

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MITCHELL FREESTONE - London

Mitchell Freestone is a 48-year-old American who has been working for a U.S. company in London for four years.

Both the American and British systems have their pros and cons, but the essential thing about the UK health system is that no-one falls through the cracks, whereas in the U.S. system, that is the big flaw.

As far as my own experience of the NHS goes, it has all been very positive. I have phoned NHS help lines, which I found to be very good and very prompt, and I have also been to walk-in centres, and was very pleasantly surprised.

I say pleasantly surprised because sometimes as an American we have an image in our minds of subsidised healthcare -- if it's provided by the government it tends to be looked down on. But my reaction has been very positive.

I really have a very high regard for the NHS -- the level of healthcare that is given on a universal basis is very impressive.

(Reporting by Kate Kelland and Ben Hirschler, editing by Sonya Hepinstall)

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