This Health Alert was written by John R. Graham.

What is unique about American health care? Americans control a smaller share of our health spending than do residents of most other developed countries. More importantly, the share of health spending controlled by Americans, rather than government or insurers, has declined much faster than it has in any other developed country (for which we have measurements) in the last couple of decades.

Chart 1 shows the share of health spending controlled directly by patients (also known as “out-of-pocket” spending) in ten developed countries, including the United States, from 1988 through 2008. (Not all countries are represented for the entire period.) Switzerland, a country widely praised for its health care, allows patients to control significantly more of their health dollars than any other country does. Out-of-pocket spending in Switzerland has fluctuated around one third of total health spending since 1998.

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