Costliest Out-of-Pocket Care

A look at the out-of-pocket costs for the OECD countries as a percentage of income. America actually doesn't make the top 10 for costliest.

While we know that Americans’ health care costs per capita are among the highest in the world, it turns out our out-of-pocket health care costs aren’t all that bad.

This list from Bloomberg looked at the out-of-pocket costs for only the OECD countries and found that the U.S. didn’t even make the top 10. The 34 countries in the Organization for Economic Co-Operation and Development are mostly high-income economies.

The countries were ranked based on the direct individual outlay of health care costs relative to income. The out-of-pocket costs were calculated by multiplying health expenditures per capita by the percentage of total health expenditures that are private and the percentage of private spending that is out of pocket. Total health expenditures cover preventive and curative services, family planning, nutrition activities and emergency aid.

The data used by Bloomberg was taken from the World Health Organization and the World Bank.

While the U.S. landed at 12 on the list because out-of-pocket costs were 1.95% of income, the country actually has the second highest health care cost per capita, behind only Switzerland. Americans also had the second highest GDP per capita. Meanwhile our neighbor to the north ranked 22nd, with out-of-pocket health expenditures at 1.55% of income.

Here are the 10 OECD countries with the costliest out-of-pocket health care.

10. Spain

Out of pocket as % of income: 2.09%

GDP per capita: $29,195

Out of pocket cost per capita: $609

Health care cost per capita: $3,027

Plaza de Reina in Valencia. Photo by Francesco Crippa.

Spain’s economy has been struggling since the recession. As Spain has the worst five-year outlook in Europe and the second highest unemployment rate, perhaps it’s not surprising that Spanish psychiatrists are the second busiest in the European Union. However, Spain has the third most paid time off.

9. Belgium

Out of pocket as % of income: 2.19%

GDP per capita: $43,413

Out of pocket cost per capita: $949

Health care cost per capita: $4,962

Riverside in Ghent

Belgium’s citizens may have high out-of-pocket costs, but its citizens are living quite well. The country has the second-highest GDP per capita in the top 10, the fourth highest minimum wage and the seventh most paid time off. However, it’s the fifteenth most rapidly aging country.

8. Hungary

Out of pocket as % of income: 2.25%

GDP per capita: $12,622

Out of pocket cost per capita: $284

Health care cost per capita: $1,085

Váci Street in Budapest’s Inner City

Perhaps out of pocket costs come from psychiatric visits — Hungary’s are the sixth busiest in the European Union. Hungarian men are also the third heaviest in the world.

7. South Korea

Out of pocket as % of income: 2.35%

GDP per capita: $22,590

Out of pocket cost per capita: $532

Health care cost per capita: $1,616

Seoul’s upscale Gangnam district. Photo by Leeyan Kym N. Fontano.

South Korea has the fastest aging within one generation — the number of people age 65 and older nearly tripled in 20 years. South Korea is one of the few countries in the OECD not considered developed and it ranks as the second best emerging market in 2013.

6. Slovakia

Out of pocket as % of income: 2.37%

GDP per capita: $16,934

Out of pocket cost per capita: $401

Health care cost per capita: $1,534

Bratislava Old Town

As the sixth heaviest country, health care is going to be important. Unfortunately, unemployment is high in Slovakia, ranking ninth for overall unemployment and sixth for youth unemployment.

5. Chile

Out of pocket as % of income: 2.6%

GDP per capita: $15,363

Out of pocket cost per capita: $399

Health care cost per capita: $1,075

Color Templeman in Valparaiso. Photo by Naslo Veliz.

Chile’s high out-of-pocket costs might be a result of a growing economy — it ranked as the eighth best emerging market in 2013 and fourteenth for GDP growth. Meanwhile, unemployment is just 6.4%.

4. Switzerland

Out of pocket as % of income: 2.88%

GDP per capita: $79,052

Out of pocket cost per capita: $2,280

Health care cost per capita: $9,121

The river Reuss in the old part of Lucerne. Photo by Simon Koopmann.

The Swiss live a long time, they have the fourth highest salaries in the OECD and their health care is the ninth most efficient. And while a lot of European countries are worried about high unemployment rates, the employment rate in Switzerland increased from 2004.

3. Mexico

Out of pocket as % of income: 2.96%

GDP per capita: $9,742

Out of pocket cost per capita: $288

Health care cost per capita: $620

Acapulco

Mexico’s health care is important since it ranked sixth for fastest aging within one generation. In 1981 3.87% of the population was 65 years and older, but in 2011 that jumped to 6.5%.

2. Portugal

Out of pocket as % of income: 3.13%

GDP per capita: $20,182

Out of pocket cost per capita: $631

Health care cost per capita: $2,311

Porto

Although the Portuguese have the most paid time off with 35 days, the country has the second greatest risk of stagflation, the second-worst five-year outlook in Europe and it’s the fourth most heavily policed country.

1. Greece

Out of pocket as % of income: 4.76%

GDP per capita: $22,083

Out of pocket cost per capita: $1,051

Health care cost per capita: $2,864

View of the Acropolis from Monastiraki. Photo by Matt Chotin.

Things aren’t looking good in Greece for a lot of reasons. The country has the highest unemployment (27.4% overall and 55.3% for those aged 15 to 25 years old). It’s one of the most rapidly aging countries and has the third-worst five-year outlook in Europe.