Cost comparative price report with AHA data addition international comparison

International Federation of
Health Plans

2009 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 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

FOR ILLUSTRATIVE PURPOSES ONLY

3


4


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
$-

UK

re
A
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US
a

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na

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Sp
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Ca

Fr

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A
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


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
$-

e
s
a

y

SA
ce

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K

ar
nd
an
ad

ai

U

ic
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Sp
rla
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an

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Fr

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C

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SA
N

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6


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
$-

e
s
y
a

n

SA
K
ce

ar
nd
an
ad

ai

U

ic
an

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Sp
rl a
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Fr

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C

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SA
N

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7


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


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.


Physician Fees:
Well-Baby Office Visit (US$)
$160
$160 $148 $148

$140
$140 USA Fee USA Fee
Range 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


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

10


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

11


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

12


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


13


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

14


Physician Fees:
Hip Replacement (US$)

$4,500
$4,000 $3,935
$3,500 USA Fee
$3,000 Range

$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


15


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


16


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
$-

SA
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17


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

$-

re
UK

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US
a

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US

18


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

19


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
$-

SA
K
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U
a

Sp

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N

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20


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
$-

SA
K
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U
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Fr

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SA
N

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21


Tests and Cultures:
Pap Smear (US$)
$70 $64
$60 USA Fee
Range
$50
$40
$30 $27 $26 $24
$16 $20 $17
$20 $14
$10

$-

SA
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22


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


23


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


24


Drug Prices:
Nexium (US$)
$450 $424

$400
USA
$350 Fee
Range
$300

$250

$200
$154
$150
$102
$100 $65 $67
$37 $36 $41
$50

$-


25


Drug Prices:
Plavix (US$)
$600
$540

$500 USA
Fee
$400 Range

$300

$200
$133
$85 $77 $85 $77
$100 $58 $59

$-


26


27

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

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

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


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


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


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

33


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


Inpatient Utilization
(American Hospitals)

Sources: American Hospital Association, “AHA Trendwatch Chartbook 2008,” 2008. 35


Hospital Revenue and Expenses per Admission
(American Hospitals)

Sources: American Hospital Association, “AHA Trendwatch Chartbook 2008,” 2008. 36

Cost comparative price report with AHA data addition international comparison

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Cost comparative price report with AHA data addition international comparison