Healthcare spending in the United States is reaching record levels. In 2024, they rose by a spectacular 8-10%, continuing an upward trend that worries economists, policyholders and expatriates alike. Costs are exploding, while mutual insurance companies are struggling to keep up, making access to care increasingly expensive. At the same time, France remains the exception, with one of the lowest out-of-pocket expenses (RAC) in the OECD. So why such divergence? And above all, what does the future hold for the American healthcare system?
Exorbitant medical costs in the United States
Medical costs in the United States are among the highest in the world. Here are a few comparisons to illustrate the gap with France:
- General practitioner consultation: between $99 and $350 in the United States, compared with €30 in France.
- CT scan: up to $5,942 without contrast media, compared with about €100 in France.
- Mammography: between $200 and $300 without insurance, compared with €70 in France.
- Vaginaldelivery: between $15,000 and $50,000 depending on the state, compared with around €3,000 in France.
These costs, which are often unpredictable and uncapped, make access to care difficult for a segment of the American population.
An inflationary, fragmented and poorly regulated healthcare system
In the United States, the absence of universal health insurance has resulted in fragmented, unequal coverage. The population depends on a patchwork of schemes:
- Public programs: Medicare (people over 65), Medicaid (modest households), Veterans Health Administration (veterans).
- Private insurance: mostly taken out through employers, with coverage varying widely from policy to policy.
- Uninsured: despiteObamacare‘s advances, more than 25 million Americans remain uninsured today.
This fragmentation leads to considerable administrative complexity, high management costs (25% of total healthcare expenditure according to the OECD) and major inequalities in access. Unlike in France or Canada, healthcare is mainly financed by individual premiums, rather than by taxes or social contributions. This makes the system more vulnerable to medical inflation.
What’s more, the USA applies a generalized fee-for-service system. Each medical service – from the hospital room to examinations to the use of equipment – is billed separately. This model encourages the multiplication of services, accentuating the surge in prices.
Conversely, countries such as France and Canada have introduced mechanisms to control expenditure: global budget envelopes, lump-sum payments or incentives for quality of care. These approaches promote macroeconomic regulation and limit inflationary drift, while ensuring universal coverage.
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France: a fairer, more regulated model
France’s healthcare system is based on universal coverage, financed by social security contributions and taxes. Social security covers a large proportion of healthcare costs, supplemented by supplementary insurance. Household out-of-pocket expenses are the lowest in the OECD, at around 7.5% in 2023.
This organization ensures more equitable access to care and limits unforeseen expenses for patients.
Comparative table of healthcare systems: United States vs France
| Criteria | United States | France |
| Healthcare expenditure (% of GDP) | Around 17% in 2022, a world record within the OECD. | Above 12.3% in 2023, among the highest in Europe. |
| Cover model | Fragmented, based on a mix of private insurance (often linked to employment) and public programs (Medicare, Medicaid). | Universal, financed by taxes and social contributions, via Social Security and complementary health insurance. |
| Access to care | Unequal, 25 million people without insurance. Coverage linked to professional status or income. | Universal access, but tensions in rural areas. Coverage independent of status or income. |
| Life expectancy (2023/2024) | 76.9 (men) / 81.8 (women), down for several years. | 80 (men) / 85.6 (women), stable since the pandemic. |
| Private sector share of expenditure | Around 50%, including private insurance and out-of-pocket expenses. | Around 20%, mainly via mutual insurance companies. |
| Refund system | Generalized fee-for-service pricing, with costs varying widely from one facility to another. | Mix of T2A and global packages, moderate out-of-pocket expenses (less than 9% on average for households). |
| Governance | Decentralized and poorly regulated: role shared between state and federal governments, insurers and service providers. | Centralized and regulated, via the State, Assurance Maladie and ARS. |
Worrying medical inflation in the United States
Healthcare costs in the United States continue to rise, with medical inflation expected to reach 10% by 2025. This increase is fuelled by rising administrative costs, fee-for-service remuneration encouraging the multiplication of benefits, and the financialization of the healthcare sector.
For expatriates and residents alike, it’s essential to take out appropriate health insurance to cover these expenses.
Why are prices soaring so fast?
A demographic boom in the over-70s
The rapid ageing of the American population mechanically leads to an increased demand for care, which is often more complex. This phenomenon is exacerbated by the prevalence of chronic illnesses (obesity, diabetes, cardiovascular disease), which adds to the long-term burden of medical expenses.
A double-edged medical innovation
The rise of cutting-edge medical technologies – robotic surgery, telemedicine, diagnostic AI – is transforming practices. For example, the Da Vinci 5 surgical robot, launched in 2024, integrates augmented reality and tactile force feedback, reducing operating times and recovery times. However, these advances require massive investment.
Exorbitant administrative costs
In the United States, around 25% of healthcare expenditure is administrative (source: OECD), a figure unmatched in comparable countries. This is due to the fragmentation of the system: multiplicity of insurers, lack of standardization of coding, variable prices. AI could alleviate this burden by automating file management, billing and care planning.
A fast-growing healthcare market
Despite this inflationary context, the healthcare sector remains one of the most dynamic in the US economy:
- By 2023-2024, healthcare services will have grown by 8-10% a year, excluding the COVID period.
- The margin rate has improved.
- 1 in 2 private-sector jobs created in 2024 will be in healthcare or social assistance.
These figures underline the extent to which the sector has become a pillar of the American economy… but at what price?
Comparative healthcare costs: United States vs. France
To better understand the extent of the differences between healthcare systems, here are a few revealing comparisons:
| Medical act | France | United States |
| General practitioner consultation | 25 € | 200 € |
| Scanner | 100 € | 1 000 € |
| Mammography | 70 € | 700 € |
| vaginal delivery | 3 000 € | 30 000 € |
These figures demonstrate the apparent efficiency of the American system. Despite spending representing almost 18% of GDP, coverage remains incomplete, with significant out-of-pocket expenses and increasingly high insurance premiums for households.
French expatriates: between coverage and precaution
For French people living in the United States, international health insurance has become essential. Without coverage, a simple hospitalization can ruin a household. By 2025, medical inflation is expected to reach 10%, with a direct impact on the cost of mutual insurance. Expatriates therefore need to anticipate, compare and choose tailor-made contracts to avoid unpleasant surprises.
Explosion of healthcare spending in the United States
The American healthcare system is at a crossroads. If innovation is synonymous with medical progress, it must be accompanied by better cost control and increased regulation.Artificial intelligence, prevention and predictive care could be viable solutions… provided there is a profound structural change.
Healthcare cannot remain a luxury reserved for those who can afford it. The real challenge is not just to innovate, but to provide more, better and cheaper care.
