Daily Archives: November 16, 2009

The Price of Physician Fees Around the World

We’ve seen that diagnostic imaging costs more in the U.S than elsewhere, but what about physician fees? This is arguably the most subjective part of the health care system. For example, do some countries value their physicians more than others? What about the emphasis on primary care versus the various specialties? Let’s start with the basic primary care office visit:

The first thing that needs to be pointed out is that the UK cost is reported as “$0.” This does not mean that office visits are “free” in the UK (though the patient does not pay anything at the point of service). Rather, this artifact arises from the fact that physicians in the UK are salaried. As such, they do not get paid a fee per visit. Moving on, we see that seeing a doctor in the U.S. is anywhere from 4 to 10 times more expensive than it is in Spain, and 2 to 5 times more expensive than it is in Canada, France, or the Netherlands. Only Australia comes anywhere close to the high prices of the U.S.

How about specialty care? Here we have three measures: normal childbirth, C-section, and appendectomy. Note that these figures include only the physician’s fee not the hospital charges. First, normal childbirth:

Can you say “Yikes!”? Again, ignoring the UK (and in this case Germany as well), we see that the U.S. charges through the nose to bring a baby into the world. But, while the difference is larger in absolute terms, it is smaller in relative terms than we observe for primary care. In this case, the U.S. prices run about 2 to 4 times that of other countries. What happens when things get more complicated and the mother needs a C-section?

Things get a bit more expensive, but the difference is relatively the same–with the exception of the U.S. “high end” which is now roughly 6 times the cost of the C-Section in Europe.

Finally, we have the appendectomy:

At the low end, the U.S. is the most expensive, but it isn’t too far off the mark. At the high end, however, the U.S. is 3 times more expensive than the next closest competitor (Australia) and nearly 18 times the cost of the appendectomy in France.

What conclusions can we draw from today’s price exploration? That the U.S. is once again the most expensive country in the world when it comes to health care prices. That the U.S. tends to charge relatively more for both primary care and specialty care. That there is no clear explanation for the difference in prices. Aren’t all appendices created equally? Isn’t the C-section a well-defined procedure with little variation from one woman to the next? In the United States, prices are not in line with the services provided. It’s that simple.

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Posted by on November 16, 2009 in Uncategorized

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