In the US, the average cost of hospital stay per day was $3,297 in 2024, second only to Iceland among 39 countries and about twice the median of the other 38, as open enrollment for 2027 plans begins.

At least seven insurers, including Cigna and Medica, have announced they will not offer Marketplace coverage in 2027, forcing consumers in 20 states to switch plans, according to the Commonwealth Fund. The Commonwealth Fund also notes that some analysts expect medical costs to grow faster in 2027 than in nearly two decades, driven by higher provider prices, prescription drug costs and health care workforce shortages.⁴

Why is healthcare so expensive in the United States?

The core reason is prices, not the volume of care. Health economists Gerard Anderson and Uwe Reinhardt and their colleagues summed up the finding in a 2003 paper titled "It's the Prices, Stupid," and a 2019 follow-up confirmed the same conclusion: the US spends more than other rich countries without delivering more services.¹

Americans actually have fewer hospital stays per person than people in peer countries, and when they do go in, they stay a shorter time: 6.5 days on average against 7.4 in peer countries.¹ The difference shows up in what payers hand over. In 2022, public health systems in peer countries paid an average of $24,847 for a heart bypass operation; Medicare paid $44,149, and private insurers paid about twice what Medicare did.¹ A RAND study of 2022 hospital prices found that private health plans paid about two and a half times what Medicare paid for the same services at the same hospitals.¹

The structural reason is a fragmented buying side. In most rich countries, a single large buyer sets or negotiates prices; in the US, many separate insurers each haggle alone, often against hospitals or drugmakers that hold the upper hand.¹ Economists Zack Cooper, Stuart Craig, Martin Gaynor and John Van Reenen found that hospitals with no rival in their market charged 12 percent more than hospitals in markets with four or more competitors, and that when two nearby hospitals merged, prices rose more than 6 percent.¹ The Peterson-KFF Health System Tracker put US health spending at $14,775 per person in 2024, against an average of $7,860 for comparable rich countries.¹

Why don't Europeans get huge medical bills?

Europeans generally do not face large individual medical bills because their governments either set prices directly or pool buying power so that a single large payer negotiates on behalf of everyone. In most rich countries, sellers who want access to the market must accept the government's or the insurer pool's terms, which keeps per-service prices far below US levels.¹

Workers in those countries fund the system through payroll contributions rather than paying premiums and then separate bills. In Germany, employees contribute roughly 8.6% of gross salary and coverage automatically extends to non-working spouses and children at no extra cost, with only small copayments, typically around 10 euros per quarter for doctor visits.² In France, direct employee health contributions are lower, around 0.5% of gross salary, though broader social contributions also fund the system.² The UK's National Health Service involves essentially no direct healthcare-specific premium for most services.²

The result is that out-of-pocket exposure at the point of care is minimal. Nearly half of US adults surveyed in the Commonwealth Fund's 2023 international study reported a medical bill concern during the previous year, and the United States is the only high-income country in that comparison without universal health coverage.⁵

What country has the highest healthcare spending?

Among the 39 countries in this chart, Iceland records the highest hospital cost per day at $3,392 in 2025, just ahead of the United States at $3,297 in 2024. Sweden ($2,796) and the Netherlands ($2,660, 2021 data) follow. At the other end, Moldova comes in at $333 a day, about a tenth of Iceland's figure.

Measured by total national health spending rather than hospital cost per day, the US leads by a wide margin. According to USAFacts, citing the Centers for Medicare and Medicaid Services, the US spent more than $4.5 trillion on personal healthcare in 2024, or $13,265 per person, up 1,306% from $943 per person in 1980, more than three times faster than general inflation over the same period.³ The Peterson-KFF Health System Tracker put the per-person figure at $14,775 in 2024, against an average of $7,860 for comparable rich countries, with even Switzerland spending almost $5,000 less per person than the US.¹

What is the average out-of-pocket medical expense for Americans?

There is no single average out-of-pocket figure because costs vary widely by insurance type, health status and the care needed, but several data points frame the range. According to USAFacts, citing CMS, out-of-pocket spending across all Americans reached $556.6 billion in 2024.³ Spread across the population that implies a significant per-person burden, though individual exposure depends heavily on coverage.

For insured workers, cost sharing starts after premiums. According to spending.watch, the typical American household earning $83,730 a year spends $9,300 to $10,300 on healthcare costs, combining premiums, deductibles, copayments and other out-of-pocket expenses, equal to 11.1% to 12.3% of gross income.² Among workers with an individual deductible in 2025, the average was $1,886, and workers at smaller companies faced an average of $2,631, according to the KFF 2025 Employer Health Benefits Survey cited by columbusblack.com.⁵

Even with coverage, debt is common. CBS News reported in September 2026 that roughly one in three working-age Americans with private health insurance are paying medical bills or debt over time, based on a Commonwealth Fund analysis of 6,353 US adults. Among those with medical debt, 46% owed at least $2,000.⁵ Sara Collins, a health economist at the Commonwealth Fund, told CBS News: "The primary reason why these people have debt is about the extent to which their insurance covers their out-of-pocket costs."⁵

Is it better to have health insurance or pay out of pocket?

For most Americans, going without insurance creates greater financial exposure, not less. KFF found that 34% of uninsured adults younger than 65 had past-due medical debt, compared with 26% of insured adults, and that 38.6% of uninsured adults ages 18 to 64 delayed or skipped needed care because of cost in 2024, against 17% of privately insured adults.⁵ Using a broader definition that includes medical expenses charged to credit cards or money owed to relatives, 62% of uninsured adults reported healthcare debt, compared with 44% of insured adults.⁵

The hospital stay cost per day in the US was $3,297 in 2024. A single inpatient day billed at that rate, with no insurer negotiating a discount and no coverage absorbing the cost, would exceed a worker's entire yearly premium contribution of $7,471 in roughly two days. Insurance also gives access to negotiated rates that uninsured patients typically cannot obtain on their own.^{1, 5}

That said, insurance does not eliminate financial risk. The Commonwealth Fund found that 32% of continuously insured working-age adults with private coverage were still paying medical bills or debt over time, and the Commonwealth Fund warns that as premiums rise for 2027, more enrollees may shift to plans with lower premiums but higher deductibles, leaving them more exposed when they do need care.^{4, 5}