American doctors charge considerably more per service than their counterparts in other countries – orthopedic surgeons’ fees are more than double what they are in five other wealthy nations, researchers reported in the journal Health Affairs. The difference between specialty care and primary care fees is also considerably greater in the US than in other industrialized countries.

These higher fees, which give American specialist physicians higher incomes, are also the main reason why overall spending on physician’s services in the USA is so much higher than elsewhere.

Miriam Laugesen and Sherry A. Glied compared the fees received by primary care offices (general practices) and hip replacements from private and public payers in the USA, UK, Germany, France, Canada and Australia.

They found that, in comparison to the other five countries:

  • US primary care physicians received 27% (average) more from public payers
  • US primary care physicians were paid 70% more by private payers
  • US orthopedic surgeons were paid 70% more by public payers
  • US orthopedic surgeons were paid 120% more by private payers

Miriam Laugesen, who was also lead author, said:

“The gap between the fees paid for primary care and those for orthopedic services such as hip replacements is significantly bigger in the United States than it is in other countries. For decades, policy makers and medical leaders in this country have debated financial incentives to spur more doctors to become primary care physicians. Our work shows that continuing attention needs to be paid to the difference in payments across specialties, and how we can get better value for those expenditures.”

Fees charged by doctors in the five countries varied widely, Laugesen and Glied found. In France, public fees paid for a primary care visit was $32, compared to $66 in the UK and $60 in the USA. Fees received by primary care practices from Medicare were more or less similar to those charged in the other five countries.

They found a very wide range of difference in fees paid for hip replacements:

  • Canada – $625 (public fees)
  • USA – $1,634 (public fees)
  • France – $1,340 (private fees)
  • USA – $3,996 (private fees)

The widest disparity in how much US physicians charge, according to this study, is in the private sector. The researchers gathered data on fees paid by six large national health insurance companies in six US markets, and found that they pay approximately one third more to primary care offices and 50% more for hip replacements compared to what Medicare pays.

The authors say that private insurers have had more success when negotiating fees with generalist physicians than with orthopedic surgeons.

Despite similar volumes of work, US doctors reported higher salaries than their counterparts in the other countries. The authors believe the differences in income are because American doctors are paid more for the time and skills. They stressed that their study was not involved in determining whether the extra pay was warranted.

Primary care physicians, average annual incomes:

  • USA – $186,582
  • France – $95,585
  • Australia – $92,844

Orthopedic surgeons, average annual incomes:

  • USA – $442,450
  • UK – $324,138

UK orthopedic surgeons earn 30% less than their US counterparts and 50% more than those in the remaining countries..

In Canada, France and Germany, primary care physicians (GPs, general practitioners) earn about 60% of what orthopedic do in their countries, while in the USA primary care physicians’ annual income is about 40% that of an American orthopedic surgeon.

This is not breaking news, the authors emphasize, that US health care fees and spending are far higher than in other nations. However, their study shows that it is not such factors as volume of services, medical school tuition fees, or higher practice costs that drive up costs, but rather the higher fees physicians are paid, particularly orthopedic surgeons.

Perhaps policy makers should consider the findings of this study when looking for ways to control health care spending, the authors suggest.

Written by Christian Nordqvist