Special Report

This Is How Americans' Medical Bills Compare to Other Countries

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10. Spain
> Per capita out-of-pocket medical spending: $760 a year (23.6% of total)
> Total per capita health care spending: $3,323 a year
> Life expectancy at birth: 83.4 years
> Population: 46.7 million

Like most countries on this list, Spain guarantees universal coverage for all its residents. The country’s public health care system is administered largely at the regional level. As is typical in countries with universal health care, Spanish residents still have some out-of-pocket expenses for prescription medications and specialist visits. Per capita out-of-pocket health care spending in the country is $760 a year.

As is the case in European countries with universal health care, Spain has a relatively healthy population. Life expectancy at birth in the country is 83.4 years, about five years longer than in the United States.

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9. Chile
> Per capita out-of-pocket medical spending: $766 a year (35.1% of total)
> Total per capita health care spending: $2,182 a year
> Life expectancy at birth: 80.2 years
> Population: 18.7 million

Chileans have higher out-of-pocket health care expenses than residents of most other OECD member countries. Per capita expenditures that fall to the consumer total $766 a year, equal to over a third of all health care spending in the country.

Chile’s health care system is a mix of public and private entities. The system is not applied to all citizens equally, however, and while workers are required to contribute 7% of their income to a health care fund, out-of-pocket costs usually disproportionately fall on lower-income families.

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8. Greece
> Per capita out-of-pocket medical spending: $767 a year (34.8% of total)
> Total per capita health care spending: $2,238 a year
> Life expectancy at birth: 81.4 years
> Population: 10.7 million

Like many countries on this list, Greece has a nationalized health care system, but residents also have the option to buy their own private health insurance plan. Hospitals in Greece will provide emergency services to anyone who needs them, regardless of whether or not they are Greek citizens.

Like most countries with a public health care system, Greeks have to pay out of pocket for a portion — 25% — of prescription medication costs. Overall, out-of-pocket health care spending in the country totals $767 a year, more than in most OECD member states.

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7. Portugal
> Per capita out-of-pocket medical spending: $783 a year (27.4% of total)
> Total per capita health care spending: $2,861 a year
> Life expectancy at birth: 81.5 years
> Population: 10.3 million

Portugal has a nationalized health care system that is available to all citizens. While health care services are free for children and retirement-age adults, residents between the ages of 18 and 65 have to pay small fees for services. All told, out-of-pocket medical expenses in the country average $783 per person annually.

The Portuguese health care system has improved considerably in recent years and is now among the most well regarded in the world. Universal coverage and quality health care likely partially explains why the country’s life expectancy at birth, at 81.5 years, is so far above the 72.4 year global average.

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6. Italy
> Per capita out-of-pocket medical spending: $791 a year (23.1% of total)
> Total per capita health care spending: $3,428 a year
> Life expectancy at birth: 83.0 years
> Population: 60.4 million

All Italian citizens and residents living in Italy have automatic and universal health care. Though the national government assures access to essential levels of care, hospitals and outpatient services are typically managed at the local level. While undocumented immigrants have access to essential srevices, visitors to the country must pay for the cost of their treatment. Over a third of all the Italian health care system’s funding comes from corporate tax revenue.

While Italians are not legally permitted to opt out of the public health care system, about 6 million people are covered through voluntary health insurance, either by paying as an individual or receiving coverage through their employer. Out-of-pocket payments are typically for specialist visit copayments or certain prescriptions not covered by the public plan.

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