Compare International Medical Bills

Countries with governments and economies similar to the United States have come up with a variety of methods to make sure that all of their citizens receive health care. While residents in Europe and Japan may pay higher insurance premiums or taxes than Americans, in the end, when all costs are added up, Americans spend more money on health care per person with fewer people covered. (Data most recent available as of July 2008.)

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United States

Population: 302 million

Life expectancy at birth: 78.1

Health spending as part of GDP: 15.3%

System type: Employer-employee based (54%) and government funding (46%). Government covers all older adults and the disabled (Medicare), the poor (Medicaid), veterans, government employees and Native Americans.

Coverage: 82% of people under 65; 100% of people 65 or over.

Average annual per-person spending:
Total: $6,402.
Breakdown: $2,884 by government; $2,676 for private insurance, with 52% paid by employers, 48% paid by employees; $842 by consumer out-of-pocket*

Financing: Larger companies self-insured. Employers and employees share costs. Income taxes fund Medicare, Medicaid and other public programs. Co-payments and deductibles highly variable in the private system.

Notable features: Leading-edge technology, drugs and facilities. Most patients can choose doctors, hospitals.

Biggest challenges: Health access for working poor. Discrepancies in care between rich and poor. Rising costs. Overuse of tests and procedures. Low international rankings on basic health measures, including infant mortality and preventable deaths.

Prescription drug coverage: Of those with insurance, 84% are covered. Most plans require co-payments. No government controls on prices or availability.

Doctors: Payments regulated in government programs; insurers set fees; no price controls for uninsured.

Hospitals: Payments regulated in government programs; insurers set fees; no price controls for uninsured.

France

Population: 61.7 million

Life expectancy at birth: 80.3

Health spending as part of GDP: 11.1%

System type: Universal coverage. Employment-based system, with supplemental private insurance.

Coverage: 100%

Average annual per-person spending:
Total: $3,374.
Breakdown: $2,693 by government, $448 on private insurance, $233 consumer out-of-pocket*

Financing: Employers pay equivalent of 13.1% of employee's salary to the national health insurance program. Employees pay 0.75% of salary. Income taxes also helps provide universal coverage for retirees, unemployed, disabled and the poor. Most people (87%) also have supplemental insurance from private for-profit insurers, which they purchase or is often paid for by an employer.

Notable features: The national system pays 100 percent of costs for people with one of 30 long-term conditions, including diabetes and cancer. Broad choice in doctors and specialists. Strong pre- and post-natal care, strong cancer case management.

Biggest challenges: Controlling costs, improving efficiency. Government currently cutting number of acute hospital beds and promoting computerized medical records to curb redundancy. Shifting some doctor duties to nurses.

Prescription drug coverage: Drug effectiveness determines patient's co-pay: 0% for most cost-effective drugs; sliding scale of 35%, 65% and 100% for drugs with more limited therapeutic value. More generics since 2006, new co-pays as of 2008.

Doctors: Government negotiates fees with doctor unions. Most are in fee-based private practice.

Hospitals: Government sets rates for most hospitals.

Germany

Population: 82.3 million

Life expectancy at birth: 79

Health spending as part of GDP: 10.7%

System type: Universal coverage. Mostly employer-employee based (88%).

Coverage: 99.8 % -- all citizens and legal residents

Average annual per-person spending:
Total: $3,673
Breakdown: $2,518 on mandatory employment-based coverage, nonprofit insurance; $259 on for-profit insurance; $349 by government; and $547 consumer out-of-pocket*.

Financing: Workers split premiums with employers, with each paying about 8% of workers' gross income to nonprofit "sickness funds." Those earning over $75,000 may purchase insurance from for-profit insurers.

Notable features: Comprehensive coverage including basic dental and long-term care. Short waits - usually less than a month - for elective surgery. New programs provide extra attention to diabetes and other chronic illnesses.

Biggest challenges: Large and growing aged population, high costs, high rate of specialist visits.

Prescription drug coverage: Full coverage with small copayments. Federal panel controls prices and an expert committee decides which new treatments should be covered.

Doctors: Regional groups of office-based doctors negotiate with insurers over annual budgets. Hospital-based doctors, including most specialists, are salaried.

Hospitals: Insurers negotiate with hospitals over annual budgets.

Great Britain

Population: 61 million

Life expectancy at birth: 79

Health spending as part of GDP: 8.3%

System type: Tax-funded, government-run.

Coverage: Universal coverage. All citizens and legal residents.

Average annual per-person spending:
Total: $2,723.
Breakdown: $2,371 by government; $352 on supplemental private insurance, OTC drugs, direct payments to doctors.

Financing: 95% of funding comes from taxes; 5% comes from user charges, such as co-payments for prescription drugs.

Notable features: "Socialized" medicine. Government directly pays doctor and hospital fees. Patients do not receive bills for National Health Service care. The government's National Institute for Health and Clinical Excellence advises which high-cost treatments should be covered.

Biggest challenges: Government doesn't cover care that it deems cost-ineffective and some cosmetic surgery. Maintaining a steady source of government funding in the face of increasingly expensive treatments and drugs.

Prescription drug coverage: Half of England's population receives drugs for free, based on exceptions for age, disability and pregnancy. Co-payments for the rest in England. Wales and Scotland have abolished all co-payments.

Doctors: Most paid by government through salary or fees; some doctors accept private insurance or fees directly from patients.

Hospitals: Paid by government, some funding from private insurers.

Netherlands

Population: 16.4 million

Life expectancy at birth: 79.4

Health spending as part of GDP: 9.2%

System type: Universal coverage. Employer-employee based system, some private financing.

Coverage: Universal coverage. 98.5% -- all citizens and legal residents.

Average annual per-person spending:
Total: $3,580.
Breakdown: $1,733 by government; $1,614 on private insurance; $223 consumer out-of-pocket*

Financing: A 7.2% tax on salaries, up to a maximum of $3,798 per year. Employers often pay two-thirds of that tax. Half of the tax goes into risk equalization fund to compensate insurers with high-risk subscribers. Adults under 65 also pay annual premiums averaging $1,614 to a private insurer of their choice. Government subsidizes seniors, disabled and the poor. Government covers costs for children under 18.

Notable features: Blend of private health insurance companies and government regulation. Consumers have wide choice of private insurers who can't deny coverage, but can decide who provides care and how much. Strong primary and after-hours care.

Biggest challenges: Controlling costs.

Prescription drug coverage: Covered by private insurance, though extent, cost and quality depend on subscriber's policy.

Doctors: Insurers negotiate rates. Two-thirds of primary care doctors in fee-based private practice. Most specialists based at hospitals and paid by salary.

Hospitals: Market-based rates negotiated with insurers.

Switzerland

Population: 7.5 million

Life expectancy at birth: 81.3

Health spending as part of GDP: 11.6%

System type: Universal coverage. Individuals must buy coverage directly from private insurers.

Coverage: All citizens and legal residents.

Average annual per-person spending:
Total: $4,177
Breakdown: $2,493 by government; $408 on private insurance; $1,276 consumer out-of-pocket*

Financing: Consumers pay for insurance premiums and uninsured expenses. Government provides subsidies for those in need of financial assistance.

Notable features: Fully private system, with government-regulated and subsidized private health care providers and insurers.

Biggest challenges: The Swiss pay more for health care than anyone else in Europe. Lower- and middle-income people pay higher proportion of income for insurance. Little consumer information about physicians and hospitals compared with United States.

Prescription drug coverage: Private insurance covers. Government controls prices; higher than in neighboring countries. Co-payments are 10%.

Doctors: Government negotiates rates with doctor organizations.

Hospitals: Government sets rates.

Japan

Population: 127.7 million

Life expectancy at birth: 82.1

Health spending as part of GDP: 8%

System type: Universal coverage. Compulsory employer-employee financed national health insurance (52%); government-paid program for people over 70, the poor and small businesses.

Coverage: 100 % -- all citizens and legal residents.

Average annual per-person spending:
Total: $2,358
Breakdown: $1,927 by government; $71 on private insurance; $360 consumer out-of-pocket*

Financing: Employers and employees each required to pay approximately 4% of salary to nonprofit, community-based insurance plan. Public assistance for small businesses and the poor. Co-payments of 30% for outpatient care; 20% for hospitalization. Ceiling on out-of-pocket costs.

Notable features: Frequent doctor visits, long hospital stays. Insurers must cover everyone; can't deny a claim.

Biggest challenges: Rapidly aging population. Overuse of care. Highest number of hospitals per person in the world. Shortage of physicians in many specialties and rural areas.

Prescription drug coverage: 30% co-payment; government controls set prices at relatively low levels.

Doctors: Government regulates fees via negotiation.

Hospitals: Mostly private; government sets rates.

Note

Out-of-pocket expenses are payments borne directly by a patient, separate from insurance fees.

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