1. International Federation of Health Plans
2012 Comparative Price Report
Variation in Medical and Hospital Prices by Country

2. International Federation of Health Plans
The International Federation of Health Plans was founded in 1968 by a small group of health
plan industry leaders. It is now the leading global network in the industry, with more than one
hundred member companies from twenty-five countries.
Federation member plans meet regularly to share information about health care financing and
health care delivery in their home countries.
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3. 2012 Survey Overview
This year’s survey includes new prescription drug prices in response to increased interest in this area from plans
in many countries. We have also added three new non-drug items to our survey: hip prosthesis, knee
replacement, and colonoscopy.
Prices for each country are submitted by participating federation member plans, and are drawn from different
sectors:
• Prices for Canada, New Zealand, Switzerland, and the United Kingdom are from the public sector, with
data provided by one health plan in each country.
• Prices for Australia, Chile, the Netherlands, Spain, and South Africa are from the private sector and
represent prices paid by one private health plan in each country.
• Prices for France and Argentina are a blend of public and private sector prices with the data provided by
one health plan in each country.
• Prices for the United States are calculated from a database with over 100 million paid claims that reflect
prices negotiated between thousands of providers and almost a hundred health plans.
Comparisons across different countries are complicated by differences in sectors, fee schedules, and systems. In
addition, for some countries a single plan’s prices are real for that plan but may not be representative of prices
paid by other plans in that market. The U.S. numbers are based on an aggregate of over a 100 million paid claims
across multiple payers.
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4. 2012 Scanning and Imaging: Angiogram
$2,430
$914
$378
$218 $235 $264
$125 $173
$35
Canada Spain Switzerland South Af rica France Chile United States
USA 25th Percentile Average Price USA 95th Percentile
($ USD)
4

5. 2012 Scanning and Imaging: CT Scan, Abdomen
$1,737
$630
$437 $472
$349
$267
$234 $243
$175 $183
$103 $118 $124
Argentina Spain Canada United France Chile Netherlands New Switzerland South Af rica United
Kingdom Zealand States
USA 25th Percentile Average Price USA 95th Percentile
($ USD)
5

6. 2012 Scanning and Imaging: CT Scan, Head
$1,672
$566
$300 $310 $328
$252
$175 $183 $192
$119 $124 $138
$82
Argentina Spain Canada United France Chile Netherlands South Af rica New Switzerland United
Kingdom Zealand States
USA 25th Percentile Average Price USA 95th Percentile
($ USD)
6

7. 2012 Scanning and Imaging: CT Scan, Pelvis
$1,565
$567
$386
$328 $349
$257
$166 $175 $183 $217
$117 $124
$66
Argentina Spain Canada Chile United France Netherlands Switzerland New South Af rica United
Kingdom Zealand States
USA 25th Percentile Average Price USA 95th Percentile
($ USD)
7

8. 2012 Scanning and Imaging: MRI
$2,871
$1,072 $1,121
$928
$502 $554
$522
$319 $335 $363
$230
$118
Argentina Spain Netherlands United France Chile New Zealand Switzerland South Af rica United States
Kingdom
USA 25th Percentile Average Price USA 95th Percentile
($ USD)
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9. 2012 Cost Per Hospital Day
$12,537
$4,287
$1,472 $1,514
$731 $853 $964 $979
$429 $476 $665
Argentina Spain South Af rica Netherlands France Chile New Zealand Australia United States
USA 25th Percentile Average Price USA 95th Percentile
($ USD)
9

10. 2012 Total Hospital and Physician Cost: Appendectomy
$29,426
$13,851
$8,156
$5,392 $5,467
$4,221 $4,498 $4,463 $4,782
$3,381 $3,408
$2,245
$953
Argentina Spain South Af rica United Chile Netherlands France Switzerland New Australia United
Kingdom Zealand States
USA 25th Percentile Average Price USA 95th Percentile
($ USD)
10

11. 2012 Total Hospital and Physician Cost: Normal Delivery
$16,653
$9,775
$6,846 $7,262
$4,039
$3,541
$2,669 $2,992
$2,386 $2,641
$2,035 $2,265
$1,188
Argentina South Af rica Spain New Netherlands United Chile France Switzerland Australia United
Zealand Kingdom States
USA 25th Percentile Average Price USA 95th Percentile
($ USD)
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12. 2012 Total Hospital and Physician Cost: C-Section
$26,305
$15,041
$10,566 $10,545
$6,441
$5,186 $5,328
$4,435 $4,717
$3,097 $3,378 $3,449
$1,541
Argentina Spain Chile South Af rica United New Switzerland Netherlands France Australia United
Kingdom Zealand States
USA 25th Percentile Average Price USA 95th Percentile
($ USD)
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13. 2012 Total Hospital and Physician Cost: Cataract Surgery
$8,143
$3,738
$2,829
$2,566
$2,205 $2,418
$1,938 $2,079
$1,867
$1,534
$1,139
$564
Argentina United Netherlands Spain France New Zealand South Af rica Switzerland Chile United States
Kingdom
USA 25th Percentile Average Price USA 95th Percentile
($ USD)
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14. 2012 Total Hospital and Physician Cost: Knee Replacement Surgery
$52,451
$25,637
$22,421
$14,849 $16,473
$13,466
$11,954
$7,827 $7,833
$3,192
Argentina Spain United Kingdom Switzerland South Af rica New Zealand Australia United States
USA 25th Percentile Average Price USA 95th Percentile
($ USD)
14

15. 2012 Total Hospital and Physician Cost: Hip Replacement
$87,987
$40,364
$27,810
$25,061
$14,390 $15,403
$11,889 $13,409
$9,574 $10,927 $11,187
$7,731
$3,365
Argentina Spain Switzerland France Netherlands United Chile New South Af rica Australia United
Kingdom Zealand States
USA 25th Percentile Average Price USA 95th Percentile
($ USD)
15

16. 2012 Total Hospital and Physician Cost: Bypass Surgery
$150,515
$73,420
$43,230 $46,547
$37,044
$26,432
$22,844
$17,437 $17,729
$12,401 $14,061 $14,117
$8,882
Argentina Chile Netherlands United Spain Switzerland France New South Af rica Australia United
Kingdom Zealand States
USA 25th Percentile Average Price USA 95th Percentile
($ USD)
16

17. 2012 Total Hospital and Physician Cost: Angioplasty
$61,649
$28,182
$16,533
$13,475 $14,366
$8,911 $9,446
$6,332 $7,010 $7,564
$5,295
$2,851
Argentina Switzerland Netherlands New Zealand France Australia Spain South Af rica United United States
Kingdom
USA 25th Percentile Average Price USA 95th Percentile
($ USD)
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18. 2012 Physician Fees: Routine Office Visit
$176
$95
$68
$38
$30 $30
$25
$10 $11
Argentina Spain South Af rica France Canada Chile United States
USA 25th Percentile Average Price USA 95th Percentile
($ USD)
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19. 2012 Physician Fees: Normal Delivery
$5,407
$3,096
$2,397
$1,837
$890
$536 $583
$292 $329
$116 $163
South Af rica Argentina Netherlands Spain Canada France Chile Australia United States
USA 25th Percentile Average Price USA 95th Percentile
($ USD)
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20. 2012 Physician Fees: C-Section
$6,593
$3,676
$2,688
$2,118
$1,084
$838 $938
$606
$428
$193 $216
Argentina South Af rica Spain Canada Netherlands France Chile Australia United States
USA 25th Percentile Average Price USA 95th Percentile
($ USD)
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21. 2012 Physician Fees: Cataract Surgery
$1,839
$1,311
$1,048
$922
$699
$651
$420 $426
$332
$286
$157
Argentina Netherlands South Af rica Spain France Canada Chile Australia United States
USA 25th Percentile Average Price USA 95th Percentile
($ USD)
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22. 2012 Physician Fees: Appendectomy
$2,044
$1,001
$776 $782
$724
$674
$539
$408
$231
$148 $157
Argentina South Af rica Spain Canada Netherlands Chile France Australia United States
USA 25th Percentile Average Price USA 95th Percentile
($ USD)
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23. 2012 Physician Fees: Hip Replacement
$5,196
$2,883 $2,888
$1,992 $1,983
$1,288
$1,088
$697 $748 $761
$461
Argentina Canada Netherlands South Af rica Spain France Chile Australia United States
USA 25th Percentile Average Price USA 95th Percentile
($ USD)
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24. 2012 Drugs: Celebrex
Celebrex is commonly prescribed for pain.
$258
$162
$163
$140
$126 $128
$116
$88
$59
$53
Canada Argentina South Af rica United Kingdom France Switzerland Spain United States
USA 25th Percentile Average Price USA 95th Percentile
($ USD)
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25. 2012 Drugs: Vytorin
Vytorin is commonly prescribed for high cholesterol.
$131
$123
$120
$80
$70
$68
$55
$31
Argentina New Zealand United Kingdom Switzerland Spain United States
USA 25th Percentile Average Price USA 95th Percentile
($ USD)
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26. 2012 Drugs: Cymbalta
Cymbalta is commonly prescribed for depression, anxiety, and fibromyalgia.
$317
$176
$149
$113
$77 $84
$70
$57
$47 $48
France United Kingdom South Af rica Spain Switzerland Argentina Canada United States
USA 25th Percentile Average Price USA 95th Percentile
($ USD)
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27. 2012 Drugs: Nasonex
Nasonex is commonly prescribed for nasal allergies.
$115
$108
$105
$39
$29
$21 $22 $23
$17
$12
United Kingdom France Spain Argentina South Af rica Canada Switzerland United States
USA 25th Percentile Average Price USA 95th Percentile
($ USD)
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28. 2012 Drugs: Lipitor
Lipitor is commonly prescribed for high cholesterol.
$145
$124
$100
$60
$48
$43
$39
$11 $13
$6
New Zealand South Af rica Spain Argentina United Kingdom France Chile United States
USA 25th Percentile Average Price USA 95th Percentile
($ USD)
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29. 2012 Drugs: Nexium
Nexium is commonly prescribed for acid reflux.
$373
$202
$187
$71 $72
$37 $41
$30 $32
$18 $21
Spain Argentina France United South Af rica Chile Switzerland Netherlands United States
Kingdom
USA 25th Percentile Average Price USA 95th Percentile
($ USD)
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30. 2012 Diagnostics: Colonoscopy
$2,627
$1,185
$864 $893
$655
$536
$413
Argentina Switzerland New Zealand United Kingdom United States
USA 25th Percentile Average Price USA 95th Percentile
($ USD)
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31. 2012 Devices: Hip Prosthesis
$27,497
$12,222
$10,763
$6,895
$3,579
$1,556 $2,682
$1,516
Argentina Chile Spain South Africa Australia United States
USA 25th Percentile Average Price USA 95th Percentile
($ USD)
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32. 2010 Health Spending as Percent of GDP
17.6%
11.4% 11.4% 11.6%
10.1%
9.6% 9.6%
9.1% 9.5%
8.0% OECD Average
Chile Australia Spain United New Zealand Canada Switzerland France United States
Kingdom
Source: OECD Health Spending 2012. Data represents 2010 or most recent year.
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33. Country Sources and Notes
Argentina Prices are a weighted average from the public system, the social security system, and a private
health plan.
Australia Prices are private sector prices paid by a private health plan.
Canada Prices are public sector prices for the province of Nova Scotia.
Chile Prices are private sector prices paid by a private health plan.
France Prices are a blend of public and private system prices.
Netherlands Prices are private sector prices paid by a private health plan, and incorporate the new DRG
system implemented in 2012.
New Zealand Prices are public sector prices based on the fee schedule for one large District Health Board, as
well as other national tariff pricing lists.
South Africa Prices are private sector prices paid by a private health plan.
Spain Prices are private sector prices paid by a private health plan.
Switzerland Prices are public sector prices.
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34. Country Sources and Notes
United States Prices are calculated from commercial claims data from the Truven (formerly Thomson Reuters)
MarketScan Research databases. The MarketScan databases capture person-specific clinical
utilization, expenditures, and enrollment from a selection of large employers, health plans, and
government and public organizations. The annual medical databases include private sector
health data from approximately 100 payers. Claims data was compiled by Deloitte Consulting
LLP on behalf of Kaiser Permanente Health Plan. Any opinions or conclusions expressed
herein regarding the data are not those of Deloitte Consulting LLP. Because a broad range of
prices were available, the national 25th percentile (low), average, and 95th percentile were
calculated. Prices represent allowed charges, which are the negotiated rates for which
providers receive payment. Allowed charges include both patient cost sharing and health plan
payment.
Cataract surgery price represents the price for outpatient procedures. The angioplasty and
appendectomy prices reflect a blend of inpatient and outpatient prices based on relative
utilization in each setting.
The patent for Lipitor expired on November 30, 2011. This has an impact on the drug’s unit
cost, and data show a rapid drop in volume and a gradual reduction in price for the branded
version of this drug throughout 2012. The price in this report was calculated based on the same
process as the other drug benchmarks, but incorporated an adjustment factor to reflect the
impact on price of patent expiration. Prices may decline further over time, and the utilization of
the drugs may also continue to decline as generic substitutes gain market share.
United Kingdom Prices are public sector prices from the National Health Service (NHS) and the British National
Formulary drug price listings.
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35. List of Federation Member Plans
Argentina Germany Spain
Omint Sa De Servicios AXA Krankenversicherung AG Compañia de Seguros Adeslas SA
Australia Munich Health Sanitas SA
Australian Health Service Alliance Greece Switzerland
Australian Health Insurance Association Limited Interamerican Life Insurance Company Helsana Versicherungen AG
Australian Unity Health Limited Hong Kong Sanitas Krankenversicherung
BUPA Australia Limited AXA General Insurance Hong Kong Limited Thailand
GMHBA Limited BUPA (Asia) Limited BUPA Health Insurance (Thailand) Limited
HBF Health Funds Inc
Hospitals Contribution Fund of Australia, Limited India United Kingdom
Health-Partners MAX BUPA Health Insurance Limited Aria Assistance Group
Medibank Private Ireland AXA PPP Healthcare
Navy Health Limited VHI Healthcare Limited BUPA
NIB Health Funds Limited InterGlobal Insurance Company
Italy Simplyhealth Group
Police Health
Unisalute Western Provident Association Limited
RT Health Fund
Teachers’ Federation Health Limited Mexico Westfield Contributory Health Scheme
Teachers’ Union Health AXA Seguros SA de CV USA
Belgium Aetna Inc
Netherlands
Medicover America's Health Insurance Plans
Achmea Health
Nationaal Verbond van Socialistiche Mutualiteiten Blue Cross & Blue Shield Association
New Zealand Emblem Foundation Health Plan
Union Nationale des Mutualities Libres (MLOZ)
Health Funds Association of New Zealand Kaiser Foundation Health Plan Inc
Canada Southern Cross Healthcare RW2 Enterprise
Alberta Blue Cross Plan Union Medical Benefits Society, Limited The Trizetto Group
Canassurance Hospital Service Association Tufts Health Plan
Nigeria
Group Medical Services UnitedHealth Group
Total Health Trust Limited
Manitoba Blue Cross
Medavie Blue Cross Poland Zimbabwe
Pacific Blue Cross Signal Iduna Polska Tusa Association of the Healthcare Funders of Zimbabwe
Saskatchewan Blue Cross Cimas Medical Aid Society
Saudi Arabia
The Medical Aid Society of Central Africa
Chile BUPA Middle East
Premier Service Medical Aid Society
Banmedica South Africa
China Board of Healthcare Funders of Southern Africa
BUPA China Representative Office Bonitas Medical Fund
Chartered Accountants (SA) Medical Aid Fund
Denmark
Discovery Health Medical Scheme
Danmark Sygeforsikring
La-Health Medical Scheme
Danica Pension Forretningsudvikling
Medihelp
Forenede Gruppeliv A/S
Medscheme Holdings
Dominican Republic Metropolitan Health Group
Ars Humano Polmed
France Transmed
Malakoff Mederic
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