among 40-year-old non-smokers was about 9 percent, according to an analysis of 17 cities, although blue cross blue shield proposed increases of 40 percent in alabama and 60 percent in texas. however, some or all of these costs are offset by subsidies, paid as tax credits. for example, the kaiser foundation reported that for the second-lowest cost "silver plan" (a plan often selected and used as the benchmark for determining financial assistance), a 40-year old non-smoker making $30,000 per year would pay effectively the same amount in 2017 as they did in 2016 (about $208/month) after the subsidy/tax credit, despite large increases in the pre-subsidy price. this was consistent nationally. in other words, the subsidies increased along with the pre-subsidy price, fully offsetting the price increases. this premium tax credit subsidy is separate from the cost sharing reductions subsidy discontinued in 2017 by president donald trump, an action which raised premiums in the aca marketplaces by an estimated 20 percentage points above what otherwise would have occurred, for the 2018 plan year. deductibles while health insurance premium cost increases have moderated in the employer market, some of this is because of insurance policies that have a higher deductible, co-payments and out-of-pocket maximums that shift costs from insurers to patients. in addition, many employees are choosing to combine a health savings account with higher deductible plans, making the impact of the aca difficult to determine precisely. for those who obtain their insurance through their employer ("group market"), a 2016 survey found that: deductibles grew by 63% from 2011 to 2016, while premiums increased 19% and worker earnings grew by 11%. in 2016, 4 in 5 workers had an insurance deductible, which averaged $1,478. for firms with less than 200 employees, the deductible averaged $2,069. the percentage of workers with a deductible of at least $1,000 grew from 10% in 2006 to 51% in 2016. the 2016 figure drops to 38% after taking employer contributions into account. for the "non-group" market, of which two-thirds are covered by the aca exchanges, a survey of 2015 data found that: 49% had individual deductibles of at least $1,500 ($3,000 for family), up from 36% in 2014. many marketplace enrollees qualify for cost-sharing subsidies that reduce their net deductible. while about 75% of enrollees were "very satisfied" or "somewhat satisfied" with their choice of doctors and hospitals, only 50% had such satisfaction with their annual deductible. while 52% of those covered by the aca exchanges felt "well protected" by their insurance, in the group market 63% felt that way. prescription drugs main article: prescription drug prices in the united states according to the oecd, u.s. prescription drug spending in 2015 was $1,162 per person on average, versus $807 for canada, $766 for germany, $668 for france, and is capped in the uk at £105.90($132) reasons for higher costs the reasons for higher u.s. healthcare costs relative to other countries and over time are debated by experts. relative to other countries bar chart comparing healthcare costs as percentage of gdp across oecd countries chart showing life expectancy at birth and health care spending per capita for oecd countries as of 2013. the u.s. is an outlier, with much higher spending but below average life expectancy. u.s. healthcare costs in 2015 were 16.9% gdp according to the oecd, over 5% gdp higher than the next most expensive oecd country. with u.s. gdp of $19 trillion, healthcare costs were about $3.2 trillion, or about $10,000 per person in a country of 320 million people. a gap of 5% gdp represents $1 trillion, about $3,000 per person relative to the next most expensive country. in other words, the u.s. would have to cut healthcare costs by roughly one-third ($1 trillion or $3,000 per person on average) to be competitive with the next most expensive country. healthcare spending in the u.s. was distributed as follows in 2014: hospital care 32%; physician and clinical services 20%; prescription drugs 10%; and all other, including many categories individually making up less than 5% of spending. these first three categories accounted for 62% of spending. a 2022 study revealed that the united states is one of the most expensive countries for a 15 minute private doctors visit. the average cost of a visit in the u.s. is $104, while the global average is $40, ranking the u.s. as the #8 most expensive country. important differences include: administrative costs. about 25% of u.s. healthcare costs relate to administrative costs (e.g., billing and payment, as opposed to direct provision of services, supplies and medicine) versus 10-15% in other countries. for example, duke university hospital had 900 hospital beds but 1,300 billing clerks. assuming $3.2 trillion is spent on healthcare per year, a 10% savings would be $320 billion per year and a 15% savings would be nearly $500 billion per year. for scale, cutting administrative costs to peer country levels would represent roughly one-third to half the gap. a 2009 study from price waterhouse coopers estimated $210 billion in savings from unnecessary billing and administrative costs, a figure that would be considerably higher in 2015 dollars. cost variation across hospital regions. harvard economist david cutler reported in 2013 that roughly 33% of healthcare spending, or about $1 trillion per year, is not associated with improved outcomes. medicare reimbursements per enrollee vary significantly across the country. in 2012, average medicare reimbursements per enrollee ranged from an adjusted (for health status, income, and ethnicity) $6,724 in the lowest spending region to $13,596 in the highest. the u.s. spends more than other countries for the same things. drugs are more expensive, doctors are paid more, and suppliers charge more for medical equipment than other countries. journalist todd hixon reported on a study that u.s. spending on physicians per person is about five times higher than peer countries, $1,600 versus $310, as much as 37% of the gap with other countries. this was driven by a greater use of specialist doctors, who charge 3-6 times more in the u.s. than in peer countries. higher level of per-capita income, which is correlated with higher healthcare spending in the u.s. and other countries. hixon reported a study by princeton professor uwe reinhardt that concluded about $1,200 per person (in 2008 dollars) or about a third of the gap with peer countries in healthcare spending was due to higher levels of per-capita income. higher income per-capita is correlated with using more units of healthcare. americans receive more medical care than people in other countries. the u.s. consumes 3 times as many mammograms, 2.5x the number of mri scans, and 31% more c-sections per-capita than peer countries. this is a blend of higher per-capita income and higher use of specialists, among other factors. the u.s. government intervenes less actively to force down prices in the united states than in other countries. stanford economist victor fuchs wrote in 2014: "if we turn the question around and ask why healthcare costs so much less in other high-income countries, the answer nearly always points to a larger, stronger role for government. governments usually eliminate much of the high administrative costs of insurance, obtain lower prices for inputs, and influence the mix of healthcare outputs by arranging for large supplies of primary-care physicians and hospital beds while keeping tight control on the number of specialist physicians and expensive technology. in the united states, the political system creates many “choke points” for diverse interest groups to block or modify government’s role in these areas." what is the reasons for the cost differences? a main reason for the cost differences between the united states and other countries is mainly the difference in healthcare systems and how everything works together. the us is driven by a fragmented and private healthcare sector, which means that income and jobs are important to be able to afford the healthcare. in other countries the healthcare is being paid through their taxation, this is countries like denmark, sweden and norway. these countries also have progressive taxation, which means that your tax rate is based of your income. the healthcare is paid through this system so everyone can be able to get to the hospital without worrying if they can afford it or not. relative to prior years the congressional budget office analyzed the reasons for healthcare cost inflation over time, reporting in 2008 that: "although many factors contributed to the growth, most analysts have concluded that the bulk of the long-term rise resulted from the health care system's use of new medical services that were made possible by technological advances..." in summarizing several studies, cbo reported the following drove the indicated share (shown as a range across three studies) of the increase from 1940 to 1990: technology changes: 38-65%. cbo defined this as "any changes in clinical practice that enhance the ability of providers to diagnose, treat, or prevent health problems." personal income growth: 5-23%. persons with more income tend to spend a greater share of it on healthcare. administrative costs: 3-13%. aging of the population: 2%. as the country ages, more persons require more expensive treatments, as the aged tend to be sicker. according to federal reserve data, healthcare annual inflation rates have declined in recent decades: 1970-1979: 7.8% 1980-1989: 8.3% 1990-1999: 5.3% 2000-2009: 4.1% 2010-2016: 3.0% while this inflation rate has declined, it has generally remained above the rate of economic growth, resulting in a steady increase of health expenditures relative to gdp from 6% in 1970 to nearly 18% in 2015.