The cost of private health insurance in South Africa is significant, especially if you are an older individual with some health care issues and medical needs. In Canada, the fact that there is a public health care system - despite all of its faults - reduces the overall spend radically. If you can even afford an expensive private insurance as, for instance, Discovery's Comprehensive plans, you will be spending an extra ZAR 10,000 per person a month. This fact reduces the price differential between living in SA and Canada significantly! After spending a year in Canada, we have found that our expenses in Toronto are roughly 15% higher than they were in Cape Town, but not double as implied by the data provided in your comparison.