The document is a comparative price report from 2010 by the International Federation of Health Plans comparing medical and hospital fees between countries. It provides data on the costs of various medical scans, procedures, hospital stays and total costs for physician and hospital services for conditions like childbirth, appendicitis, hip replacement and bypass surgery. Across all categories, the US has among the highest costs, often 2-3 times higher than other countries at the average and even more so at the 95th percentile of actual payments made.

1. International Federation of
Health Plans
2010 Comparative Price Report
Medical and Hospital Fees by Country
1

2. COMPARATIVE COST REPORT
The International Federation of Health Plans was
founded in 1968 by a group of health plan industry
leaders from a dozen countries. It is now the leading
global network of the industry, with one hundred
member companies in 30 countries.
Federation member plans meet regularly to share
information about health care financing and health
care delivery in their home countries.
2

3. COMPARATIVE COST REPORT
The attached comparative healthcare price report was
presented at the iFHP Council meeting in November
2010 held in San Francisco, California, as part of a
discussion of total health care cost differences
between major countries.
3

4. Scans and Imaging Fees:
Angiogram (US$)
(95th percentile)
$2,500
$2,160
$2,000
$1,500
$1,000 $749 $682 (Average)
$545 $552 $559
$500 $245 $287
$117 $134 $187 $153
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USA Low USA Average USA 95th Percentile (Actual Payments)
4

5. Scans and Imaging Fees:
CT Scan: Abdomen (US$)
(95th percentile)
$1,800
$1,564
$1,600
$1,400
$1,200
$1,000
$800
$536 (Average)
$600 $447 $487
$411
$400 $374
$187 $249
$200 $85 $117 $179 $164
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USA Low USA Average USA 95th Percentile (Actual Payments)
5

6. Scans and Imaging Fees:
CT Scan: Head (US$)
(95th percentile)
$1,600 $1,430
$1,400
$1,200
$1,000
$800
$600 $464 (Average)
$400 $360
$220 $227 $234 $287
$179 $187
$200 $60 $65 $117 $82
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USA Low USA Average USA 95th Percentile (Actual Payments)
6

7. Scans and Imaging Fees:
CT Scans: Pelvis (US$)
(95th percentile)
$1,600
$1,404
$1,400
$1,200
$1,000
$800
$600 $487 (Average)
$374 $386 $391
$400 $302
$187 $215
$200 $98 $117 $179 $142
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USA Low USA Average USA 95th Percentile (Actual Payments)
7

8. Scans and Imaging Fees:
MRI Scan (US$)
(95th percentile)
$3,000
$2,590
$2,500
$2,000
$1,500
$1,009 (Average)
$1,000 $874
$603 $632
$439 $505 $509
$500 $304 $398
$86 $187 $234
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USA Low USA Average USA 95th Percentile (Actual Payments)
8

9. Hospital Charges:
Average Cost Per Hospital Day (US$)
(95th percentile)
$16,000
$14,306
$14,000
$12,000
$10,000
$8,000
$6,000
$3,220 $3,612 (Average)
$4,000
$2,000 $340 $470 $543 $554 $617 $909 $1,183 $1,595
$319
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USA Low USA Average USA 95th Percentile (Actual Payments)
9

10. Hospital Charges:
Average Cost Per Hospital Stay (US$)
(95th percentile)
$50,000 $45,902
$45,000
$40,000
$35,000
$30,000
$25,000
$20,000
$14,427 (Average)
$15,000
$10,000 $7,707
$4,140 $4,626 $4,715 $4,718 $5,825 $5,951
$5,000 $1,253 $1,679 $4,001
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USA Low USA Average USA 95th Percentile (Actual Payments)
10

11. Total Hospital and Physician Costs:
Normal Delivery (US$)
(95th percentile)
$16,000
$13,799
$14,000
$12,000
$10,000 $8,435 (Average)
$8,000
$6,379
$6,000 $4,592
$3,768
$4,000 $2,667 $2,792 $3,133 $3,485
$2,147 $2,266
$2,000 $737
$668
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USA Low USA Average USA 95th Percentile (Actual Payments)
11

12. Total Hospital and Physician Costs:
C-Section (US$)
(95th percentile)
$25,000
$21,989
$20,000
$15,000 $13,016
(Average)
$10,000 $9,012 $9,282
$5,192 $5,591
$5,000 $4,376 $4,648
$2,989
$959
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USA Low USA Average USA 95th Percentile (Actual Payments)
12

13. Total Hospital and Physician Costs:
Appendectomy (US$)
(95th percentile)
$30,000
$25,344
$25,000
$20,000
$15,000 $13,123 (Average)
$10,000
$6,526 $7,758
$4,624 $5,406 $5,276
$5,000 $2,537 $2,570 $2,795 $3,285 $3,456 $3,810
$559
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USA Low USA Average USA 95th Percentile (Actual Payments)
13

14. Total Hospital and Physician Costs:
Hip Replacement (US$)
(95th percentile)
$80,000 $75,369
$70,000
$60,000
$50,000
$40,000 $34,454 (Average)
$30,000
$20,069 $21,247
$20,000 $12,629 $12,737 $15,041 $15,329 $15,860
$6,683 $9,327 $9,637 $10,753
$10,000 $2,968
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USA Low USA Average USA 95th Percentile (Actual Payments)
14

15. Total Hospital and Physician Costs:
Bypass Surgery (US$)
$140,000 (95th percentile)
$126,182
$120,000
$100,000
$80,000
$60,000
$59,770 (Average)
$40,000 $32,934 $37,793
$30,474
$27,237
$22,212
$19,180
$20,000 $15,802 $16,325
$11,618 $13,998
$4,959
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USA Low USA Average USA 95th Percentile (Actual Payments)
15

16. Total Hospital and Physician Costs:
Angioplasty (US$)
(95th percentile)
$70,000
$60,448
$60,000
$50,000
$40,000
$30,000 $29,055 (Average)
$20,000 $18,283
$12,581
$6,055 $6,709 $7,666 $8,003
$10,000 $2,708 $5,223
$1,641
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USA Low USA Average USA 95th Percentile (Actual Payments)
16

17. Physician Fees:
Routine Office Visit (US$)
(95th percentile)
$180 $156
$160
$140
$120
$100 $86 (Average)
$80
$61
$60 $46 $47
$31 $39
$40 $24
$11 $15
$20 $8
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USA Low USA Average USA 95th Percentile (Actual Payments)
17

18. Physician Fees:
Normal Delivery (US$)
$6,000
(95th percentile)
$5,000 $4,848
$4,000
$2,997
$3,000 (Average)
$2,380
$2,000
$1,336
$776 $958
$1,000
$503
$129 $324
$-
Argentina Spain Canada Australia Chile France USA Fee
Range
USA Low USA Average USA 95th Percentile (Actual Payments)
18

19. Physician Fees:
C-Section (US$)
(95th percentile)
$7,000
$6,125
$6,000
$5,000
$4,000 $3,505 (Average)
$3,000 $2,656
$2,000 $1,581
$1,336
$958
$1,000 $422 $600
$148
$-
Argentina Spain Canada Chile France Australia USA Fee
Range
USA Low USA Average USA 95th Percentile (Actual Payments)
19

20. Physician Fees:
Appendectomy (US$)
(95th percentile)
$2,500
$2,072
$2,000
$1,393 $1,450
$1,500
$1,209
$1,000 $959 (Average)
$753
$647
$500 $271 $356
$119 $228
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USA Low USA Average USA 95th Percentile (Actual Payments)
20

21. Physician Fees:
Cataract Surgery (US$)
(95th percentile)
$2,500
$2,210
$2,000 $1,790
$1,500
$1,077 $1,158
$954 (Average)
$1,000
$502 $560 $632
$413 $464
$500
$120
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USA Low USA Average USA 95th Percentile (Actual Payments)
21

22. Physician Fees:
Hip Replacement (US$)
(95th percentile)
$6,000
$5,280
$5,000
$4,000
$2,723 $2,748 $2,834 (Average)
$3,000 $2,588
$1,962 $2,008
$2,000
$1,071
$1,000 $679 $815
$370
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USA Low USA Average USA 95th Percentile (Actual Payments)
22

23. Drug Prices:
Lipitor (US$)
(95th percentile)
$160
$140 $134
$120 $129
$100
$78 $78
$80 $72
$60
$31 $33 $38 $39
$40 $30 $31
$20
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USA Low USA 95th Percentile (Actual Payments)
23

24. Drug Prices:
Nexium (US$)
$400
(95th percentile)
$339
$350
$300
$250
$200 $186 (Average)
$136
$150 $167
$100 $69
$49 $50
$50 $21 $30 $32 $33 $35
$3
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USA Low USA Average USA 95th Percentile (Actual Payments)
24

25. Drug Prices:
Plavix (US$)
(95th percentile)
$180 $161
$160
$152 (Average)
$140 $148
$120
$98 $99
$100
$76 $80
$80
$55 $57 $59
$60 $46
$40 $33
$20 $15
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USA Low USA Average USA 95th Percentile (Actual Payments)
25

26. Contact information
Tom Sackville, Chief Executive, the International Federation of
Health Plans
Tom Sackville, Chief Executive of the International Federation of Health
Plans was born in London and gained a degree in Modern History and
Spanish Literature from Oxford University. He began his working life in
financial services in New York, specializing in European and Latin
American debt. In 1983 he was elected to the British Parliament, later
serving as a Government Whip in the Thatcher administration and as a
Minister in the Department of Health and the Home Office under John
Major. He has served as Chief Executive of the iFHP since 1998.
Email: tom@ifhp.com
UK cell: +44 7710 787 673
26

27. List of Federation Member Plans
Argentina Greece
Omint Sa De Servicios Interamerican Life Insurance Company
Australia Hong Kong
Australian Health Insurance Association BUPA (Asia) Limited
Australian Unity Health Limited HSBC Medical Insurance Limited
BUPA Australia Limited India
GMHBA Limited MAX BUPA Health Insurance Limited
HBF Health Funds Inc Ireland
The Hospitals Contribution Fund of VHI Healthcare Limited
Australia Limited Spain
Italy
Health Partners Compañia de Seguros Adeslas SA
Unisalute
Medibank Private Sanitas SA
Mauritius
Navy Health Limited Switzerland
Administrators & Consultants Limited
NIB Health Funds Limited Helsana Versicherungen AG
Netherlands
RT Health Fund Sanitas
Achmea Health
Teachers’ Federation Health Limited Thailand
Zorgverzkeraars Nederland
Teachers’ Union Health BUPA Health Insurance (Thailand) Limited
New Zealand
Belgium Turkey
Southern Cross Healthcare
Medicover Acibadem Saglik ve Hayat Sigorta S.A.
Health Fund Association of New Zealand
Association Internationale de la Mutualite United Kingdom
Unimed
Nationaal Verbond van Socialistiche Mutualiteiten AXA PPP Healthcare
Nigeria
Union Nationale des Mutualities Libres (MLOZ) BUPA
Total Health Trust Limited
Botswana Europe Assistance Holdings
People's Republic of China
Botswana Public Medical Aid Scheme Healthways International Limited
BUPA China Representative Office
PULA Medical Aid Fund Simplyhealth Group
Romania
Canada Western Provident Association
Medihelp International Broker De Asigurare SRL
Alberta Blue Cross Plan Westfield Contributory Health Scheme
Saudi Arabia
Canassurance Hospital Service Association USA
BUPA Middle East
Group Medical Services Aetna Inc
South Africa
Manitoba Blue Cross America's Health Insurance Plans
Agility Global Health Scheme
Medavie Blue Cross Blue Cross & Blue Shield Association
Board of Healthcare Funders of Southern Africa
Pacific Blue Cross HIP Health Plan of New York
Bonitas Medical Fund
Saskatchewan Blue Cross Kaiser Foundation Health Plan Inc
Chartered Accountant (SA) Medical Aid Fund
Chile The Trizetto Group
Discovery Health
Banmedica Zimbabwe
La-Health Medical Scheme
Colombia CIMAS Medical Aid Society
Medihelp
Asociacion Colombiana de Empresas de Medicina Integral The Medical Aid Society of Central Africa
Medscheme Holdings
Denmark Metropolitan Health Group
Danmark Sygeforsikring Neil Harvey & Associates
Dominican Republic Polmed
Ars Humano Sizwe Medical Fund
France Transmed
Malakoff Mederic University of Natal
Germany
Munich Health
27

28. Source and Notes For Health Care
Unit Price Comparisons
UK Based on NHS fee schedule
Australia Average hospital charges per day and stay : Based on Productivity
Commission October 2009 report
Drugs : Reflects standard co-payments for patient
New Zealand Physician fees for office visits : not covered by private health
insurance. government subsidy for General Practitioner visits (primary
care capitation). Subsidies will vary depending on the eligibility of the
patient. This calculated fee relates to the average cost not covered by
the subsidy.
Physician fees for normal delivery and c-sections : not covered by
private health insurance. fully funded by the government
Average hospital charges per day and per stay : Include all surgical
procedures funded under private insurance. Cover a wide range of
procedures and thus the average prices are heavily determined
according to the mix of procedures within.
28

29. Source and Notes For Health Care
Unit Price Comparisons (Cont’d)
France Drugs : Reflect prices negotiated by hospitals including a 2.1% tax.
These prices that are generally much lower than drugs available in
primary care settings and pharmacies
Drugs - Lipitor : Reflects the prices for the generic substitute, Tahor
Germany Based on current Medical Fee Schedule (GOA) and represents the
average costs per treatment
Total (Hospital and Physician) Cataract surgery fees : Excluded due
to limited and non-comparable data definitions
Normal delivery physician fees : Reflects only the incremental private
insurance fees paid to physicians above the annually negotiated
medical fees which consists of fees per time period and per medical
procedure. e.g., only incremental physician charges above the
bundled DRG payment for specific procedures which consists of
both total physician and hospital cost
Drugs : Reflect commercially available prices. No public fees
available. Public co-payment schemes also vary greatly
29

30. Source and Notes For Health Care
Unit Price Comparisons (Cont’d)
Netherlands Physician primary care fees (office visits) : No equivalent in Dutch
health system. General Practitioner remuneration system is based
on a fixed fee per patient plus an additional 9 Euro consult fee.
Total (Hospital and Physician) fees : Estimated based on DBC
(diagnose treatment combinations) which are negotiated mixed
bundled payments model on per patient / diagnosis basis.
Components are not separated
Drugs : Reflect the standard public charges for patient. Excludes 6%
VAT
Switzerland All fees except for physician inpatient fees are based on public fee
schedule
Physician inpatient fees (Normal Delivery, C-Section,
Appendectomy, Cataract Surgery, Hip Replacement) : Based on
private charges billed by hospitals for medical services. Physician
specific component is not separated
30

31. Source and Notes For Health Care
Unit Price Comparisons (Cont’d)
Spain Fee schedule is as of Oct 2010 and reflects the competitive fees
charged by private providers.
Argentina Reflects a blend of fees for three health sub sectors; public health,
social security and private weighed by corresponding coverage of
the total population - 50%, 38% and 12% respectively.
Canada Hospital and Total (Hospital and Physician) fees : reflect 2009/10
relative hospital cost, based using fiscal 2009/10 acute care
discharge data from the Canada Institute for Health Information
(CIHI) Discharge Abstract Database and a relative dollar value of
$5,422 (fiscal 2008/09 - New Brunswick provincial average) for 1
RIW (resource intensity weights) or cost per weighted case (CPWC)
as provided by CIHI.
31

32. Source and Notes For Health Care
Unit Price Comparisons (Cont’d)
Canada Average cost per hospital day : Includes only direct cost (no indirect
(Cont’d) or overhead cost)
Average cost per hospital admission : Based on acute hospitals only
and includes newborns
Drugs : Reflects one month supply (30 days) covering base
ingredient costs excluding mark-up and dispensing fees. Given that
Nexium is not included in the New Brunswick Formulary, the
comparable product, Losec, was used
Cost-based fees are not captured at a detailed level for various
procedures including c-sections, angiograms
USA US data are from independent databases tracking payment levels by
third party payers, and publicly reported sources. These reflect
commercially negotiated claims-based, fee-for-service paid charges
between payers and providers / hospitals. For total hospital and
physician fees consists of physician, facility and other fees for the
procedures that have been performed in inpatient settings. These
fees vary widely by state, by specialty, by hospital and by payer
32