International Federation of
Health Plans
2010 Comparative Price Report
Medical and Hospital Fees by Country
1
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
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
FOR ILLUSTRATIVE PURPOSES ONLY
Scans and Imaging Fees:
Angiogram (US$)
(95th percentile)
$2,500
$2,160
$2,000
$1,500
$1,000
$545
$500
$117
$134
$187
$682 (Average)
$287
$245
$153
USA Low
Fe
e
R
an
ge
an
d
US
A
Ze
al
a
Ne
w
le
Ar
ge
nt
in
c
Ch
i
lia
an
y
USA Average
Au
st
ra
b
G
er
m
Fr
an
ce
Sw
it z
er
la
nd
a
UK
3
Sp
ai
n
$-
8
6
4
2
0
$552
$749
$559
USA 95th Percentile (Actual Payments)
4
FOR ILLUSTRATIVE PURPOSES ONLY
Scans and Imaging Fees:
CT Scan: Abdomen (US$)
(95th percentile)
$1,564
$117
$85
$187
$179
$374
$249
$411
$536 (Average)
$487
$447
$164
USA Low
USA Average
an
ge
e
R
lia
Fe
US
A
c
Au
st
ra
Sw
it z
er
la
nd
Ne
w
Ze
al
an
d
an
y
le
Ch
i
UK
b
G
er
m
a
Fr
an
ce
Sp
ai
n
a
3
Ar
ge
nt
in
8$61
6
4
2
0
Ca
na
da
$1,800
$1,600
$1,400
$1,200
$1,000
$800
$600
$400
$200
$0
USA 95th Percentile (Actual Payments)
5
FOR ILLUSTRATIVE PURPOSES ONLY
Scans and Imaging Fees:
CT Scan: Head (US$)
(95th percentile)
$1,600
$1,430
$1,400
$1,200
$1,000
$800
$600
$464 (Average)
$400
$117
$65
$179
$227
$220
$287
$234
$360
$82
USA Low
USA Average
Sw
it z
er
US
la
nd
A
Fe
e
R
an
ge
lia
an
y
G
er
m
c
Au
st
ra
an
d
Ne
w
Ze
al
le
UK
b
Ch
i
a
Fr
an
ce
3
Sp
ai
n
Ar
ge
nt
in
a
$0
8
$60
6
4
2
0
Ca
na
da
$200
$187
USA 95th Percentile (Actual Payments)
6
FOR ILLUSTRATIVE PURPOSES ONLY
Scans and Imaging Fees:
CT Scans: Pelvis (US$)
(95th percentile)
$1,404
$1,600
$1,400
$1,200
$1,000
$800
$600
$400
$117
$179
$187
$374
$302
$215
$391
$487 (Average)
$142
USA Low
USA Average
lia
Sw
it z
er
la
US
nd
A
Fe
e
R
an
ge
Au
st
ra
c
G
er
m
an
y
an
d
Ne
w
Ze
al
UK
b
Fr
an
ce
a
le
3
Ch
i
Ca
na
da
$0
8 $98
6
4
2
0
Sp
ai
n
$200
$386
USA 95th Percentile (Actual Payments)
7
FOR ILLUSTRATIVE PURPOSES ONLY
Scans and Imaging Fees:
MRI Scan (US$)
(95th percentile)
$3,000
$2,590
$2,500
$2,000
$1,500
$874
$1,000
$86
$187
$234
$304
$398
$509
USA Low
USA Average
Sw
it z
er
US
la
nd
A
Fe
e
R
an
ge
an
y
G
er
m
an
d
Ne
w
c
Ze
al
le
lia
Ch
i
b
Au
st
ra
Fr
an
ce
a
Ca
na
da
3
Sp
ai
n
Ar
ge
nt
in
a
$-
8
6
4
2
0
UK
$500
$632
$603
$505
$439
$1,009 (Average)
USA 95th Percentile (Actual Payments)
8
FOR ILLUSTRATIVE PURPOSES ONLY
Hospital Charges:
Average Cost Per Hospital Day (US$)
(95th percentile)
$16,000
$14,306
$14,000
$12,000
$10,000
$8,000
$6,000
$3,220
$4,000
$319
$340
$470
$543
$554
$617
$909
$1,183
$1,595
USA Low
US
A
Fe
e
R
an
ge
an
d
Ze
al
lia
Ne
w
Au
st
ra
c
Fr
an
ce
an
y
USA Average
Sw
it z
er
la
nd
b
G
er
m
le
Ch
i
a
Sp
ai
n
Ca
na
da
3
Ar
ge
nt
in
$-
6
4
2
0
a
$2,000 8
$3,612 (Average)
USA 95th Percentile (Actual Payments)
9
FOR ILLUSTRATIVE PURPOSES ONLY
Hospital Charges:
Average Cost Per Hospital Stay (US$)
(95th percentile)
USA Low
USA Average
an
ge
R
e
US
A
Fe
Ca
na
da
le
Ch
i
an
d
Ze
al
an
y
c
Ne
w
G
er
m
b
Fr
an
ce
lia
Sw
it z
er
la
nd
a
Au
st
ra
Sp
ai
n
Ar
ge
nt
in
2
0
a
$50,000
$45,902
$45,000
$40,000
$35,000
$30,000
$25,000
$20,000
$14,427 (Average)
$15,000
$10,000 8
$5,825 $5,951 $7,707
$4,715
$4,626
$4,718
$4,001
$5,000 6 $1,253 $1,679 $4,140
3
4
$-
USA 95th Percentile (Actual Payments)
10
FOR ILLUSTRATIVE PURPOSES ONLY
Total Hospital and Physician Costs:
Normal Delivery (US$)
(95th percentile)
$16,000
$13,799
$14,000
$12,000
$10,000
$8,435 (Average)
$8,000
$6,000
$4,000
$3,768
$2,792 $3,133 $3,485
$737
an
ge
Fe
e
R
lia
US
A
Au
st
ra
c
Fr
an
ce
Ch
i
le
Sw
it z
er
la
nd
b
UK
Ca
na
da
G
er
m
a
Sp
ai
n
an
y
3
a
Ne
th
er
la
nd
s
$0
8$668
6
4
2
0
Ar
ge
nt
in
$2,000
$2,667
$2,147 $2,266
$6,379
$4,592
USA Low
USA Average
USA 95th Percentile (Actual Payments)
11
FOR ILLUSTRATIVE PURPOSES ONLY
Total Hospital and Physician Costs:
C-Section (US$)
(95th percentile)
$25,000
$21,989
$20,000
$15,000
$13,016
$9,012
$10,000
$5,000
$2,989
$959
$4,648
$5,192
$9,282
$5,591
USA Low
USA Average
an
ge
R
e
Fe
Au
st
ra
lia
U
SA
c
N
et
he
rla
nd
s
U
K
b
Sw
it z
er
la
nd
a
Fr
an
ce
Sp
ai
n
a
3
Ar
ge
nt
in
8
$- 6
4
2
0
$4,376
(Average)
USA 95th Percentile (Actual Payments)
12
FOR ILLUSTRATIVE PURPOSES ONLY
Total Hospital and Physician Costs:
Cataract Surgery (US$)
(95th percentile)
$40,000
$35,189
$35,000
$30,000
$25,000
$20,000
$14,764 (Average)
$15,000
$10,000
$3,352
$927 $1,299 $1,667 $1,815 $2,365 $2,495 $2,633
$5,626 $5,909
USA Low
USA Average
an
ge
le
Fe
e
R
Ch
i
US
A
Fr
an
ce
an
d
Ze
al
lia
c
Ne
w
b
Au
st
ra
Sp
ai
n
a
Ne
th
er
la
nd
s
Sw
it z
er
la
nd
3
UK
Ar
ge
nt
in
a
$-
8
6 $351
4
2
0
Ca
na
da
$5,000
USA 95th Percentile (Actual Payments)
13
FOR ILLUSTRATIVE PURPOSES ONLY
Total Hospital and Physician Costs:
Appendectomy (US$)
(95th percentile)
$30,000
$25,344
$25,000
$20,000
$15,000
$13,123 (Average)
USA Low
USA Average
an
ge
R
lia
Fe
e
US
A
an
d
Ze
al
le
Ch
i
Au
st
ra
c
Ne
w
UK
Ne
th
er
la
nd
s
b
Ca
na
da
G
er
m
a
an
y
3
Fr
an
ce
Ar
ge
nt
in
a
$-
8$559
6
4
2
0
Sw
it z
er
la
nd
$5,000
$6,526 $7,758
$4,624 $5,406 $5,276
$3,810
$3,456
$3,285
$2,537 $2,570 $2,795
Sp
ai
n
$10,000
USA 95th Percentile (Actual Payments)
14
FOR ILLUSTRATIVE PURPOSES ONLY
Total Hospital and Physician Costs:
Hip Replacement (US$)
(95th percentile)
$80,000
$75,369
$70,000
$60,000
$50,000
$40,000
$34,454
USA Low
USA Average
lia
Fe
e
Ze
a
Au
st
ra
d
la
n
y
an
$20,069 $21,247
US
A
c
Ne
w
er
m
G
Ch
ile
s
3
he
rla
nd
ce
Fr
an
b
Ne
t
a
ad
a
in
$9,327
Sp
a
la
n
d
$6,683
Ca
n
Ar
g
en
tin
a
$-
$2,968
8
6
4
2
0
Sw
i tz
er
$10,000
$12,629 $12,737 $15,041 $15,329 $15,860
$9,637 $10,753
UK
$20,000
Ra
ng
e
$30,000
(Average)
USA 95th Percentile (Actual Payments)
15
FOR ILLUSTRATIVE PURPOSES ONLY
Total Hospital and Physician Costs:
Bypass Surgery (US$)
(95th percentile)
$140,000
$126,182
$120,000
$100,000
$80,000
$59,770
$60,000
USA Low
USA Average
$27,237
$22,212
$30,474
$37,793
$32,934
an
ge
an
d
US
A
Fe
e
R
Ze
al
lia
Ne
w
Au
st
ra
G
er
m
c
an
y
3
Ca
na
da
$19,180
Ne
th
er
la
nd
s
b
$16,325
Fr
an
ce
a
$13,998
$15,802
Sp
ai
n
$11,618
UK
Ar
ge
nt
in
$-
a
$20,000
8
6
4
2$4,959
0
Sw
it z
er
la
nd
$40,000
(Average)
USA 95th Percentile (Actual Payments)
16
FOR ILLUSTRATIVE PURPOSES ONLY
Total Hospital and Physician Costs:
Angioplasty (US$)
(95th percentile)
$70,000
$60,448
$60,000
$50,000
$40,000
$29,055 (Average)
$30,000
$20,000
$2,708
$6,055
$5,223
$7,666
$6,709
$8,003
USA Low
USA Average
an
ge
an
d
US
A
Fe
e
R
Ze
al
Sp
ai
n
lia
Fr
an
ce
c
Ne
w
b
Au
st
ra
an
y
G
er
m
a
Sw
it z
er
la
nd
le
3
Ch
i
Ar
ge
nt
in
$-
8 $1,641
6
4
2
0
a
$10,000
$18,283
$12,581
USA 95th Percentile (Actual Payments)
17
FOR ILLUSTRATIVE PURPOSES ONLY
Physician Fees:
Routine Office Visit (US$)
(95th percentile)
$180
$156
$160
$140
$120
$100
$86
$80
$60
$39
$31
$24
$15
$11
USA Low
USA Average
R
an
ge
lia
Fe
e
tr a
U
SA
Au
s
c
C
hi
le
ad
a
ce
C
an
Ze
a
N
ew
b
Fr
an
la
n
y
an
er
m
a
d
3
G
Ar
g
en
tin
a
$-
8
6 $8
4
2
0
in
$20
Sp
a
$40
$61
$47
$46
(Average)
USA 95th Percentile (Actual Payments)
18
FOR ILLUSTRATIVE PURPOSES ONLY
Physician Fees:
Normal Delivery (US$)
$6,000
(95th percentile)
$4,848
$5,000
$4,000
$2,997
$3,000
(Average)
$2,380
$2,000
8
6
4
$1,000
2
0
$-
$1,336
$776
$129
Argentina
USA Low
b
Spain
$958
$503
$324
a
3
Canada
USA Average
c
Australia
Chile
France
USA Fee
Range
USA 95th Percentile (Actual Payments)
19
FOR ILLUSTRATIVE PURPOSES ONLY
Physician Fees:
C-Section (US$)
(95th percentile)
$7,000
$6,125
$6,000
$5,000
$4,000
$3,505 (Average)
$3,000
$2,656
$2,000
$1,000
8
6
4
2
0
$422
$148
$-
a
Argentina
USA Low
$600
$958 3
b
Spain
Canada
USA Average
$1,336
$1,581
c
Chile
France
Australia
USA Fee
Range
USA 95th Percentile (Actual Payments)
20
FOR ILLUSTRATIVE PURPOSES ONLY
Physician Fees:
Appendectomy (US$)
(95th percentile)
$2,500
$2,072
$2,000
$1,393
$1,500
$1,450
$1,209
$1,000
$959 (Average)
$753
$647
USA Low
USA Average
an
ge
an
d
US
A
Fe
e
R
Ze
al
le
Ne
w
c
Ch
i
lia
Au
st
ra
b
Fr
an
ce
an
y
Ca
na
da
a
G
er
m
Sp
ai
n
3
Ar
ge
nt
in
$-
6
4
2
0
$271
$228
$119
a
$500 8
$356
USA 95th Percentile (Actual Payments)
21
FOR ILLUSTRATIVE PURPOSES ONLY
Physician Fees:
Cataract Surgery (US$)
(95th percentile)
$2,500
$2,210
$2,000
$1,790
$1,500
$1,077
$1,158
$954
$1,000
$632
$560
$502
$464
$413
USA Low
USA Average
an
ge
le
US
A
Fe
e
R
Ch
i
Fr
an
ce
an
d
c
Ze
al
Ne
w
an
y
b
G
er
m
Ca
na
da
Au
st
ra
a
lia
3
Sp
ai
n
a
$120
Ar
ge
nt
in
$500 8
6
4
$- 2
0
(Average)
USA 95th Percentile (Actual Payments)
22
FOR ILLUSTRATIVE PURPOSES ONLY
Physician Fees:
Hip Replacement (US$)
(95th percentile)
$6,000
$5,280
$5,000
$4,000
$3,000
$2,588
$2,834 (Average)
$2,748
$1,962
$2,000
$679
$370
$2,008
$1,071
$815
USA Low
USA Average
an
ge
Fe
e
R
lia
US
A
Au
st
ra
Fr
an
ce
Ze
al
c
an
d
le
Ne
w
b
Ch
i
Sp
ai
n
G
er
m
a
Ca
na
da
an
y
3
Ar
ge
nt
in
6
4
2
0
a
$1,000 8
$-
$2,723
USA 95th Percentile (Actual Payments)
23
FOR ILLUSTRATIVE PURPOSES ONLY
Drug Prices:
Lipitor (US$)
(95th percentile)
$160
$134
$140
$120
$129
$100
3.5
USA Low
an
ge
US
A
Fe
e
R
an
y
UK
c
G
er
m
b
Sw
it z
er
la
nd
a
le
$0.43
Ch
i
0
$78
$39
a
$0
$38
Ar
ge
nt
in
1
$33
$31
lia
$20
$31
Au
st
ra
1.5
$30
Sp
ai
n
$40
Ca
na
da
2
0.5
$78
$60
Ne
th
er
la
nd
s
2.5
Fr
an
ce
3
$72
$80
USA 95th Percentile (Actual Payments)
24
FOR ILLUSTRATIVE PURPOSES ONLY
Drug Prices:
Nexium (US$)
(95th percentile)
$400
$339
$350
$300
$250
$186
$200
$136
$150
$100
$21
$30
$33
$69
$50
$49
$35
$167
USA Low
USA Average
R
an
ge
Fe
e
U
SA
G
er
m
an
y
d
er
la
n
in
Sw
i tz
c
Sp
a
C
hi
le
s
he
rla
nd
lia
b
N
et
ad
a
tr a
Au
s
a
C
an
en
tin
a
U
K
3
Ar
g
Fr
an
$-
8
6 $3
4
2
0
ce
$50
$32
(Average)
USA 95th Percentile (Actual Payments)
25
FOR ILLUSTRATIVE PURPOSES ONLY
Drug Prices:
Plavix (US$)
(95th percentile)
$180
$161
$160
$140
$152 (Average)
$148
$120
$59
$57
$55
$46
$33
USA Low
Ra
ng
e
y
US
A
Fe
e
an
in
Ch
ile
er
m
G
c
Sp
a
ad
a
d
la
n
Ca
n
b
Sw
i tz
er
UK
a
en
tin
Ar
g
nd
he
rla
a
Ne
t
tr a
lia
s
3
Au
s
8$15
6
4
2
0
Fr
an
$-
$80
$76
ce
$40
$20
$99
$98
$100
$80
$60
USA Average
USA 95th Percentile (Actual Payments)
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
27
List of Federation Member Plans
Argentina
Omint Sa De Servicios
Australia
Australian Health Insurance Association
Australian Unity Health Limited
BUPA Australia Limited
GMHBA Limited
HBF Health Funds Inc
The Hospitals Contribution Fund of
Australia Limited
Health Partners
Medibank Private
Navy Health Limited
NIB Health Funds Limited
RT Health Fund
Teachers’ Federation Health Limited
Teachers’ Union Health
Belgium
Medicover
Association Internationale de la Mutualite
Nationaal Verbond van Socialistiche Mutualiteiten
Union Nationale des Mutualities Libres (MLOZ)
Botswana
Botswana Public Medical Aid Scheme
PULA Medical Aid Fund
Canada
Alberta Blue Cross Plan
Canassurance Hospital Service Association
Group Medical Services
Manitoba Blue Cross
Medavie Blue Cross
Pacific Blue Cross
Saskatchewan Blue Cross
Chile
Banmedica
Colombia
Asociacion Colombiana de Empresas de Medicina Integral
Denmark
Danmark Sygeforsikring
Dominican Republic
Ars Humano
France
Malakoff Mederic
Germany
Munich Health
Greece
Interamerican Life Insurance Company
Hong Kong
BUPA (Asia) Limited
HSBC Medical Insurance Limited
India
MAX BUPA Health Insurance Limited
Ireland
VHI Healthcare Limited
Italy
Unisalute
Mauritius
Administrators & Consultants Limited
Netherlands
Achmea Health
Zorgverzkeraars Nederland
New Zealand
Southern Cross Healthcare
Health Fund Association of New Zealand
Unimed
Nigeria
Total Health Trust Limited
People's Republic of China
BUPA China Representative Office
Romania
Medihelp International Broker De Asigurare SRL
Saudi Arabia
BUPA Middle East
South Africa
Agility Global Health Scheme
Board of Healthcare Funders of Southern Africa
Bonitas Medical Fund
Chartered Accountant (SA) Medical Aid Fund
Discovery Health
La-Health Medical Scheme
Medihelp
Medscheme Holdings
Metropolitan Health Group
Neil Harvey & Associates
Polmed
Sizwe Medical Fund
Transmed
University of Natal
Spain
Compañia de Seguros Adeslas SA
Sanitas SA
Switzerland
Helsana Versicherungen AG
Sanitas
Thailand
BUPA Health Insurance (Thailand) Limited
Turkey
Acibadem Saglik ve Hayat Sigorta S.A.
United Kingdom
AXA PPP Healthcare
BUPA
Europe Assistance Holdings
Healthways International Limited
Simplyhealth Group
Western Provident Association
Westfield Contributory Health Scheme
USA
Aetna Inc
America's Health Insurance Plans
Blue Cross & Blue Shield Association
HIP Health Plan of New York
Kaiser Foundation Health Plan Inc
The Trizetto Group
Zimbabwe
CIMAS Medical Aid Society
The Medical Aid Society of Central Africa
28
FOR ILLUSTRATIVE PURPOSES ONLY
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.
29
FOR ILLUSTRATIVE PURPOSES ONLY
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
30
FOR ILLUSTRATIVE PURPOSES ONLY
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
31
FOR ILLUSTRATIVE PURPOSES ONLY
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.
32
FOR ILLUSTRATIVE PURPOSES ONLY
Source and Notes For Health Care
Unit Price Comparisons (Cont’d)
Canada
(Cont’d)
Average cost per hospital day : Includes only direct cost (no indirect
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
33