GORINCHEM, Netherlands ? In France, a visit to the doctor typically costs the equivalent of $1.12.
A night in a German hospital costs a patient roughly $11.
And in the Netherlands ? one of the few wealthy nations other than the U.S. where patients face a deductible ? insurers usually must cover all medical care after the first 385 euros, roughly $431.
Health care in the U.S. has long been unique. But few things so starkly set the American system apart as how much patients pay out of pocket for medical care, even if they have insurance.
?The U.S. likes to see itself on par with other high-income countries,? said Jonathan Cylus, a former economist at the Department of Health and Human Services who now studies patient costs internationally at the World Health Organization and European Observatory in London. ?The truth is, it?s a real outlier.?
Nearly all of America?s global competitors ? whether they have government health plans, such as Britain and Canada, or rely on private insurers, such as Germany and the Netherlands ? strictly limit out-of-pocket costs.
So while tens of millions of insured Americans must balance medical bills with spending on food and other basic needs, such trade-offs are largely unthinkable for patients in Western Europe, Japan and Australia, a Times examination of international health insurance systems shows.
?We only have to worry about getting well,? said Pieter Piers, a 57-year-old Dutch engineer who was talking with his family doctor earlier this year about work-related stress in Gorinchem, a walled city in the table-flat farmland of southern Netherlands.
?If I had to worry about how to pay for it all, I don?t think that would be very helpful for getting better,? said Piers, one of dozens of patients and physicians worldwide interviewed for this story, including at clinics and hospitals in Germany, Britain and the Netherlands.
The Netherlands, like many wealthy countries, mandates that visits with primary care doctors are free so patients won?t be discouraged from seeking care.
By contrast, as deductibles in job-based health plans in the U.S. have more than tripled in the last decade, half of Americans who have coverage through an employer say they or close family members have put off going to the doctor or filling a prescription because of cost in the last year, according to a nationwide survey conducted for this project by The Times and the nonprofit Kaiser Family Foundation.
One in six covered workers has had to make a difficult sacrifice in the previous year, including taking on extra work or cutting back on food, clothing or other essentials, the poll found.
In the Netherlands, just 1 in 90 households faces catastrophic health spending that competes with necessities such as food and housing, a recent World Health Organization analysis of patient spending in three dozen countries found.
In Ireland, Great Britain, Sweden, France, Germany and Japan, fewer than 1 in 35 households had medical bills that threatened their financial security.
The financial struggles of American patients have prompted renewed calls by some Democrats for a government-run, single-payer system, or ?Medicare for all,? as it is sometimes called.
But the experiences of other wealthy nations suggest that strict limits on how much patients must pay and tight regulation of prices are more consequential than whether health coverage is provided directly by the government or through private insurers.
