Healthcare is completely crap here, even if you have a 'good' plan you end up paying through the nose. You pay monthly, you pay every time you go to the dr, have a test run, anything. It is pretty much impossible to truly figure out what you are going to pay if you do anything more than see your regular dr. It is a lot of stupid jumping through hoops too. For instance, my kid had to see a specialist podiatrist (sports). He had to see a regular dr first (not normal with our insurance). So I paid for that visit. Then had to go elsewhere for X-rays. Turns out although the clinic we went to for the X-rays is covered under our insurance, the dr at the clinic wasn't so that cost us a fortune. You pay for the dr, for the X-rays and for your treatment at the clinic -- plus a large sum for the boot they made him wear. Then I had to call the insurance to get the podiatrist "pre-authorized" which we also had to partly pay for. Blah blah blah.
That said, we love living here. We came for two years. Ha ha. We kept a bunch of our stuff for when we came back only we didn't. We've been here 13 years.
One thing I wish I had known is that the languages are very different but people will expect you to understand. Also it is really really hard at times for at least six months. You may well cry and want to go home and feel lonely and that things are done a really crazy way. It also feels a little surreal, like you are permanently on holiday. After six month things improve a lot and by two years it feels a lot like home.
We live in an expensive area and we still feel that economically we are a lot better off. I agree that kid activities cost a tiny fortune. We pay about $500 per kid four times a year for one sport each PLUS fees for matches, traveling, coaches gifts etc.
If I had to do it again I absolutely would. It was exhausting but has been a fantastic experience.