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International comparisons of health care prices from the 2017 iFHP survey

The International Federation of Health Plans (iFHPiFHPiFHP), a CEO network of the global health insurance industry based in London, in partnership with the Health Care Cost Institute (HCCI) in the United States, and iFHP member companies in eight countries, today published the latest International Comparison of Health Prices Report. The report compares the median prices paid by a sample of private health insurance companies for specific health care services in nine countries. Comparisons across different countries are complicated by differences in sectors, fee schedules, and prices may not be representative of prices paid by other plans in that market. We attempted to minimize these limitations by selecting services with very specific definitions and wording survey questions to match the procedures that are the basis of the US payment system.

The median prices paid by private insurance for health care services in the United States was almost always higher than the median prices in the eight other countries included in the iFHP study. Figure 1 shows the prices paid for medical services in each country as a percent of the US price.

Key Findings:

    • Holland had the lowest prices for hip and knee replacements with prices less than 25% of the US price. Prices for hip and knee replacements in the United Arab Emeritus (UAE) were the closest to the US at 71% of the price.
    • Bypass surgery was less than half the price of the US in all the other countries included in the study. 
    • New Zealand had the highest price for cataract surgery, 124% of the US price.

Figure 2 shows the prices paid for drugs in each country as a percent of the US price. US prescription drug prices are average point-of-sale price, which reflects discounts from the wholesale price, but not manufacturer rebates.

Key Findings:

    • Drug prices for most countries were less than half the US price for most of the administered and prescription drugs included in the study.
    • The prices paid for Kalydeco, a medication used to treat cystic fibrosis, were closer to the US price than other drugs. The highest price for Kalydeco was in the UAE, 137% of the US price. The lowest price was in Holland at 66% of US price.

Figure 3 shows the prices paid for each service in each country in 2017, converted at prevailing 2017 exchange rates to US dollars. Toggle through the four service categories - hospital admissions, physician/outpatient, administered drugs, and prescription drugs – at the top of the figure and select specific services using the buttons on the right.

Methods Note

Prices for the United States identified patients ages 0 to 64 with employer-sponsored insurance (ESI). The sample was limited to individuals with valid age and gender and enrolled in a preferred provider organization (PPO), health maintenance organization (HMO), point of service (POS), or exclusive provider organization (EPO) plan. For procedures under the hospital admissions category as well as specific physician/outpatient services (outpatient appendectomy, cataract, and colonoscopy), median prices included those designated for the most common DRG or CPT code as well as all ancillary services provided on the same date. All other physician/outpatient services (angiogram, cardiac catheterization, CT scan abdomen, MRI scan) were median prices associated with the procedure of interest. Administered and prescription drug prices were total allowed amounts divided by total units for CPT or NDC codes of interest. Allowed amount per unit prices were then multiplied by a factor to show the cost for the specified dosage units. Prescription drug prices for the United States were average point-of-sale prices. For detailed description of services see service description documentation.

International prices for Australia, Germany, Holland, New Zealand, South Africa, Switzerland, the United Arab Emirates, and the United Kingdom are derived from unpublished local industry sources for median prices, collected and collated by the IFHP.  United Kingdom drug prices were derived from the 2019 British National Formulary, which form the basis for public and private drug prices.