Taiwan, Mexico and Costa Rica have been ranked as the top spots to live and work abroad in 2021, based on their cost of living, ease of settling in and overall quality of life.

The U.S. was ranked only 34th out of 59 places, largely because of how expats viewed quality of life in America, according to a new survey published Tuesday.

Taiwan topped the charts for the third year in a row in the survey of 12,420 expats conducted by InterNations, a Munich-based expat network with about 4 million members. Expats appreciated Taiwan’s medical care, on top of quality of life. A full 96% of respondents were happy with the quality of care, compared with 71% globally. Expats also reported they were more satisfied with their job security in Taiwan and state of the local economy than their peers in other locales.

Health was, of course, of particular concern for expats this year. InterNations measured the role Covid-19 has played in the lives of expats, but its pandemic-related findings did not influence locations’ overall rankings. Globally, 45% of respondents said the pandemic had some influence on their time abroad or plans to go abroad.

Expats ranked Mexico and Costa Rica second and third. Both earned high marks for getting settled, which can be a difficult transition in other countries. Kuwait, Russia and Japan scored particularly low in this category. In Kuwait, 46% of expats said they did not feel at home in the local culture and 51% had difficulty finding new friends. In Japan, only 45% said they felt at home with the local culture. And in Russia, 48% of expats said it was difficult to live in the country’s cities without speaking the local language.

Some 85% of respondents said it was easy to get settled down in Mexico, while 91% of expats described Costa Rica’s population as “generally friendly.” Four in five expats in Mexico said they were satisfied with their financial situations, and 84% of expats in Costa Rica said their disposable household income was “enough or more than enough” to cover all their expenses.

Kuwait, Italy and South Africa were at the bottom of the list. Kuwait came in last place for the seventh time in eight years, earning poor marks for quality of life. Some expats noted its lack of leisure options. In Italy, 30% of expats said they were dissatisfied with their financial situation. And expats in South Africa reported low scores for job security and happiness with the state of the local economy.

The U.S., which often doesn’t do well in these kinds of surveys, received low scores for quality of life and cost of living. Expats reported a distaste for some elements of the health-care system: Just 20% were satisfied with its affordability, and 19% say the quality of care is negative. That compares with a global average of 14% who rate their care negatively.

The survey showed a wide divergence in the way expats stay informed about the pandemic. In Bahrain and Singapore, 75% and 74% of expats respectively said they relied on official government channels for information about Covid. However in New Zealand, 69% of expats said they relied on the local news, as did 65% of those in Australia and 60% in the U.K. And in several Gulf states, large majorities of expats said they relied on social media for Covid news, with 59% in Oman, 55% in Saudi Arabia and 53% in Kuwait.

There was also a disparity in how expats rated official Covid communications and related regulations. Expats gave New Zealand, Singapore and Australia top scores. Brazil clocked in at the bottom in terms of Covid communication, with Egypt in second-to-last place. The U.S. ranked near the bottom for communication about Covid-19, at 54th place.

Of course, the survey was conducted in January of this year, and a lot has changed since then, particularly regarding the pandemic.

Bloomberg previously ranked the best and worst places to be during the pandemic. Singapore, New Zealand and Australia topped the charts in April. Yet even within the past few days, Singapore has moved back into lockdown as Covid cases have increased. New Zealand's and Australia's vaccination campaigns have lagged those in other parts of the world.

Currently Mainland China has administered the most vaccine doses, followed by the U.S. and the EU.

This article was provided by Bloomberg News.