The document presents comparative cost data on medical procedures, physician fees, hospital charges, tests, and drug prices across several countries. It shows that prices for services like CT scans, physician office visits, hospital stays, and hip replacements tend to be higher in the United States than other countries like Canada, France, Germany, and the UK. The data was compiled by the International Federation of Health Plans to inform discussions around differences in total healthcare costs between nations.

1. Tom Sackville
Chief E
Chi f Executive
ti
International Federation of Health Plans
( U it d Kingdom )
United Ki d
S
Saturday, 4 S
d September 2010
b

2. International Federation of
Health Plans
2009 Comparative Price Report
Medical and Hospital Fees by Country
1

3. 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 31 countries.
Federation member plans meet regularly to share information
about health care financing and health care delivery in their
home countries.
The attached comparative health care provider report was
developed for the Federation council meeting, September 2-4
2009, in Preignac, France, as part of a discussion of total health
care cost differences between major countries.
2

4. FOR ILLUSTRATIVE PURPOSES ONLY
3

5. FOR ILLUSTRATIVE PURPOSES ONLY
4

6. FOR ILLUSTRATIVE PURPOSES ONLY
Scans and Imaging Fees:
CT Scan: Abdomen (US$)
$1,800 $1,600
$1,600 USA Fee
$1,400 Range
$1,200
$1,000 $750
$800 $530
$600 $400
$400 $248 $319 $258 $161 $179
$200 $83
$-
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US
USA Average USA High-end
5
Note: Canadian scan prices include the government “reading” fee and the
charges used by private scanning facilities for patients who pay their own

7. FOR ILLUSTRATIVE PURPOSES ONLY
Scans and Imaging Fees:
CT Scan: Head (US$)
$2,000 $1,800
$1,800
USA Fee
$1,600 Range
$1,400
$1,200 $950
$1,000
$800
$530
$600
$319 $300
$400 $212 $258
$161 $179
$200 $41
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USA Average USA High-end
6
Note: Canadian scan prices include the government “reading” fee and the
charges used by private scanning facilities for patients who pay their own

8. FOR ILLUSTRATIVE PURPOSES ONLY
Scans and Imaging Fees:
CT Scans: Pelvis (US$)
$2,000 $1,700
$1,800 USA Fee
$1,600 Range
$1,400
$1,200 $950
$1,000
$800 $530
$600 $300
$400 $248 $319 $258
$161 $179
$200 $83
$-
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USA Average USA High-end
7
Note: Canadian scan prices include the government “reading” fee and the
charges used by private scanning facilities for patients who pay their own

9. FOR ILLUSTRATIVE PURPOSES ONLY
Scans and Imaging Fees:
MRI Scan (US$)
$1,800 $1,500
$1,600 USA Fee Range
$1,400 $1,200
$1,200
$1,000 $824 $839
$800
$567
$600 $436 $500
$400 $235 $179
$200
$-
Canada France Germany Netherlands Spain UK USA USA
Medicare
USA Average USA High-end
8
Note: There are no Canadian government fees associated with MRIs because this equipment is typically
purchased by local health authorities and is included with fees for facility-level use.

10. FOR ILLUSTRATIVE PURPOSES ONLY
Physician Fees:
Well-Baby Office Visit (US$)
$160
$160 $148 $148
$140
$140 USA Fee
Range
$120
$120
$100 $88
$100 $88
$80
$80
$60
$38
$40 $30
$60
$22
$20 $38 $15
$40 $30
$- $22
$20 $15
Canada France Germany Spain USA
$-
Canada France Germany Spain USA
USA Low-end USA High-end
9

11. FOR ILLUSTRATIVE PURPOSES ONLY
Physician Fees:
Routine Office Visit (US$)
$160 $151
$140 USA Fee
Range
$120
$100
$80 $72
$59
$60
$40 $30 $31 $32
$22
$20 $15
$-
Canada France Germany Netherlands Spain USA USA Medicare
USA Low-end USA High-end
10

12. FOR ILLUSTRATIVE PURPOSES ONLY
Physician Fees:
Normal Delivery (US$)
$6,000
$4,847
$5,000
USA Fee
$4,000 Range
$3,000 $2,384
$2,000 $1,601
$1,023 $1,041
$1,000 $498 $622
$-
Canada France Netherlands Spain USA USA Medicare
USA Low-end USA High-end
11

13. FOR ILLUSTRATIVE PURPOSES ONLY
Physician Fees:
C-Section (US$)
$7,000
$6,094
$6,000
USA Fee
Range
$5,000 US Fee
Range
$4,000
$3,000 $2,618
$1,812
$2,000
$1,478
$915 $1,051 $1,139
$1,000
$0
Canada France Netherlands Spain USA USA Medicare
USA Low-end USA High-end
12

14. FOR ILLUSTRATIVE PURPOSES ONLY
Physician Fees:
Appendectomy (US$)
$2,000 $1,803
$1,800
$1,600 USA Fee
$1,400 Range
$1,200
$1,000
$800 $629
$600
$600 $494
$313 $376
$400 $285
$114
$200
$-
Canada France Germany Netherlands Spain USA USA
Medicare
USA Low-end USA High-end
13

15. FOR ILLUSTRATIVE PURPOSES ONLY
Physician Fees:
Cataract Surgery (US$)
$2,000
$1,731
$1,800
$1,600 USA Fee
$1,400 Range
$1,200
$1,000
$800
$573 $653 $600
$530
$600 $496
$392
$400 $302
$200
$-
Canada France Germany Netherlands Spain USA USA Medicare
USA Low-end USA High-end
14

16. FOR ILLUSTRATIVE PURPOSES ONLY
Physician Fees:
Hip Replacement (US$)
$4,500
$3,935
$4,000
USA Fee
$3,500 Range
$3,000
$2,500
$2,000
$1,554 $1,269 $1,400
$1,500
$1,000 $727 $587
$500 $126
$-
Canada France Germany Spain USA USA
Medicare
USA Low-end USA High-end
15

17. FOR ILLUSTRATIVE PURPOSES ONLY
Hospital Charges:
Average Cost Per Hospital Day
(US$)
$14,000 $12,708
$12,000
USA Fee
$10,000 Range
$8,000
$6,000
$3,181
$4,000
$2,200
$2,000 $837 $1,050
$550 $502 $579
$-
Canada France Germany Netherlands Spain USA USA
Medicare
USA Average USA High-end
16

18. FOR ILLUSTRATIVE PURPOSES ONLY
Hospital Charges:
Average Cost Per Hospital Stay (US$)
$45,000 $40,680
$40,000
$35,000 USA Fee
Range
$30,000
$25,000
$20,000
$15,000 $12,549
$9,840 $12,000
$9,043
$10,000
$3,535 $3,388
$5,000 $2,261
$-
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USA Average USA High-end
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19. FOR ILLUSTRATIVE PURPOSES ONLY
Total Hospital and Physician Costs:
Appendectomy (US$)
$30,000 $26,373
$25,000 USA Fee
Range
$20,000
$15,000 $11,997
$10,400
$10,000
$5,000 $2,436 $2,700 $2,500 $2,700 $2,959 $2,634
$-
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UK
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USA Average USA High-end
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20. FOR ILLUSTRATIVE PURPOSES ONLY
Total Hospital and Physician Costs:
Bypass Surgery (US$)
$140,000
$116,798
$120,000
USA Fee
$100,000 USA Fee
Range
Range
$80,000
$56,472
$60,000
$40,000
$22,092
$20,000 $14,111 $11,916 $15,761 $12,868
$-
Canada France Spain UK USA USA Medicare
USA Average USA High-end
19

21. FOR ILLUSTRATIVE PURPOSES ONLY
Total Hospital and Physician Costs:
Hip Replacement (US$)
$100,000
$90,000
$80,000 $67,983
$70,000
$60,000 USA Fee
Range
$50,000
$40,000 $32,093
$30,000
$17,500
$20,000
$10,000 $8,438 $8,200 $8,500 $7,600 $9,152 $8,347
$-
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USA Average USA High-end
20

22. FOR ILLUSTRATIVE PURPOSES ONLY
Total Hospital and Physician Costs:
Normal Delivery (US$)
$14,000 $12,226
$12,000 USA Fee
Range
$10,000
$7,473
$8,000 $7,259
$6,000
$4,000 $2,800 $3,400
$2,555 $1,924
$1,957
$2,000 $1,000
$-
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USA Average USA High-end
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23. FOR ILLUSTRATIVE PURPOSES ONLY
Tests and Cultures:
Pap Smear (US$)
$70 $64
$60 USA Fee
Range
$50
$40
$30 $27 $26 $24
$16 $20 $17
$20 $14
$10
$-
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USA Low-end USA High-end
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24. FOR ILLUSTRATIVE PURPOSES ONLY
Tests and Cultures:
Throat Culture (US$)
$35
$32
$30
USA Fee
Range
$25
$20 $17 $17
$15
$9 $10 $9
$10
$5
$-
Canada Germany Spain USA USA Medicare
USA Low-end USA High-end
23

25. FOR ILLUSTRATIVE PURPOSES ONLY
Drug Prices:
Lipitor (US$)
$400
$350 $334
$300 USA
Fee
$250 Range
$200
$150 $125
$100
$63
$53 $48 $40
$50 $33 $32
$-
Canada France Germany Netherlands Spain UK USA
USA Low-end USA High-end
24

26. FOR ILLUSTRATIVE PURPOSES ONLY
Drug Prices:
Nexium (US$)
$450 $424
$400
$350 USA
Fee
$300 Range
$250
$200
$154
$150
$102
$100 $65 $67
$37 $36 $41
$50
$-
Canada France Germany Netherlands Spain UK USA
USA Low-end USA High-end
25

27. FOR ILLUSTRATIVE PURPOSES ONLY
Drug Prices:
Plavix (US$)
$600
$540
$500 USA
Fee
$400 Range
$300
$200
$133
$85 $77 $85 $77
$100 $58 $59
$-
Canada France Germany Netherlands Spain UK USA
USA Low-end USA High-end
26

28. FOR ILLUSTRATIVE PURPOSES ONLY
27

29. Contact information
Tom Sackville, Chief Executive, the International Federation of Health Plans
Tom was born in London in 1950. He gained a degree in Modern History and
Spanish Literature from Oxford University, and 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. He served as a Government
Whip in the Thatcher administration and later as a Minister in the
Department of Health and the Home Office.
Since 1998 he has been Chief Executive of the International Federation of
Health Plans, a global network of leading health insurers with members in 30
countries dedicated to the maintenance of high professional and ethical
standards across the industry.
28

30. Contact information continued
Tom Sackville
Tom is an advisor to various healthcare enterprises, including a hospital IT
service provider. He is Chairman of Renal Services plc, a provider of
kidney dialysis in the UK and Italy, and of the board of trustees of The
Family Survival Trust, a charitable foundation supporting victims of cults
and their families.
email tom@ifhp.com
UK cell +44 7710 787 673
29

31. List of Federation Member Plans
Argentina France
Omint Sa De Servicios Malakoff Mederic
Australia Greece
Australian Health Insurance Association Interamerican Life Insurance Company
Australian Unity Health Limited Hong Kong
BUPA Australia Limited BUPA (Asia) Limited
GMHBA Limited HSBC Medical 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
Teachers’ Federation Health Limited Tanzania
Achmea Health
Teachers’ Union Health Strategis Insurance (Tanzania) Limited
Zorgverzkeraars Nederland
Belgium Thailand
New Zealand
Association Internationale de la Mutualite BUPA Health Insurance (Thailand) Limited
Southern Cross Healthcare
Nationaal Verbond van Socialistiche Mutualiteiten Turkey
Health Fund Association of New Zealand
Union Nationale des Mutualities Libres (MLOZ) Acibadem Saglik ve Hayat Sigorta S.A.
Unimed
Botswana United Kingdom
Nigeria
Botswana Public Medical Aid Scheme AXA PPP Healthcare
Total Health Trust Limited
PULA Medical Aid Fund BUPA
People's Republic of China
Brazil Europe Assistance Holdings
BUPA China Representative Office
Amil Participacoes LTDA Simplyhealth Group
Saudi Arabia
Canada Western Provident Association
BUPA Middle East
Alberta Blue Cross Plan Westfield Contributory Health Scheme
South Africa
Canadian Life & Health Insurance Association USA
Allcare Administration Limited
Canassurance Hospital Service Association Aetna Inc
Bathobile Holdings Limited
Group Medical Services America's Health Insurance Plans
Board of Healthcare Funders of Southern Africa
Manitoba Blue Cross Blue Cross & Blue Shield Association
Bonitas Medical Fund
Medavie Blue Cross Blue Cross & Blue Shield of Massachusetts
Chartered Accountant (SA) Medical Aid Fund
Pacific Blue Cross Blue Cross & Blue Shield of Wyoming
Discovery Health
Saskatchewan Blue Cross HIP Health Plan of New York
La-Health Medical Scheme
Chile Kaiser Foundation Health Plan Inc
Medihelp
Banmedica Venezuela
Medscheme Holdings
Colombia Sanitas Venezuela SA
Metropolitan Health Group
Asociacion Colombiana de Empresas de Medicina Integral Zimbabwe
Neil Harvey & Associates
Colsanitas SA CIMAS Medical Aid Society
Polmed
EPS Sanitas SA The Medical Aid Society of Central Africa
Resolution Health
Medisanitas SA Sizwe Medical Fund
Denmark Transmed
Danmark Sygeforsikring University of Natal
Dominican Republic
Ars Humano
30

32. FOR ILLUSTRATIVE PURPOSES ONLY
Resources For Health Care Unit Price
Comparisons
1. Pricelist for Dutch Hospitals:
http://www.umcutrecht.nl/subsite/Prijslijsten_DBC-zorg/Prijslijsten_DBC-zorg/
(For a description of how Dutch DBCs compare to DRGs, please see:
http://www.dbconderhoud.nl/Over-de-DBC-systematiek/Information-in-english)
2. The Canadian Institute for Health Information Health Spending Databases
(hospital costs):
http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=spend_e
3. Canada Diagnostic Centres:
http://www.canadadiagnostic.com/fee-schedule.php
31

33. FOR ILLUSTRATIVE PURPOSES ONLY
Resources For Health Care Unit Price
Comparisons – cont.
4. Selected Canadian Fee Schedules:
Alberta:
http://www.health.alberta.ca/professionals/SOMB.html
British Columbia:
http://www.health.gov.bc.ca/msp/infoprac/physbilling/payschedule/index.html
Manitoba:
www.manitoba.ca/health/documents/physmanual.pdf
Newfoundland:
http://www.health.gov.nl.ca/mcp/html/schedule/toc.htm
Saskatchewan:
http://www.health.gov.sk.ca/payment-schedules
32

34. FOR ILLUSTRATIVE PURPOSES ONLY
Resources For Health Care Unit Price
Comparisons – cont.
5. French Diagnosis-Related Groups (DRGs):
http://arimpl.free.fr/uploads/d96da9ec-081f-106f.pdf
6. German Diagnosis-Related Groups (DRGs):
http://www.g-drg.de/cms/
7. USA Medicare Physician Fee Schedules:
http://www.cms.hhs.gov/pfslookup/02_PFSsearch.asp?agree=yes&next=Accept
8. Wiley InterScience Special Issue: Analysing the variation of health care
treatment costs in Europe, Volume 17 Issue S1 , Pages S1 - S103
(January/February 2008):
http://www3.interscience.wiley.com/journal/117882416/issue?CRETRY=1&SRETRY=0
9. New Choice Health (medical cost comparison resource):
http://newchoicehealth.com/home
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35. FOR ILLUSTRATIVE PURPOSES ONLY
Resources For Health Care Unit Price
Comparisons – cont.
10. United States Prices and Fee Sources:
– Scans and Imaging : USA charges include physician and facility fees. Non-Medicare US data reflect
the average and maximum quotes provided by an online price comparison site
– Physician Fees : Non-Medicare US low- and high-end charges reflect an estimate of the 25th and
95th percentile of charges
– Hospital Charges / Total Hospital and Physician Costs : Non-Medicare US average to high-end
range reflect an estimate of the average and 95th percentile of charges
– Tests and Cultures : Non-Medicare US charges low- and high-end reflect an estimate of 25th and
95th percentile of charges. Medicare US charges reflect the nation wide average
– Drug Prices : Non-Medicare charges, the low-end reflects the lowest prices based on a sample of
several online US-based internet retail sites while the high-end reflects the maximum price across 61
counties based on a state-wide survey of New York retail pharmacies
34