Administrative costs are high here — no surprise given the hordes of clerks and accountants needed to deal with insurance paperwork. And technological advances, which are sometimes highly beneficial and sometimes not, often cost a lot more than standard treatments. (Surprisingly, American doctors lag far behind their counterparts abroad in using electronic health records, which can help avoid costly errors and duplications.) Insurance companies’ profits and the high pay of their executives may account for some of the cost differences with other countries, but there is little good data on this.

A recent report from the Organization for Economic Cooperation and Development, a 34-member group that includes the most advanced industrial nations, concluded that spending is high here partly because the prices charged by American doctors and hospitals are higher than they are anywhere else.

The International Federation of Health Plans, in its 2010 comparative price report, documented just how large the price differential can be for a wide range of services. While it’s difficult to get data that is truly comparable from one country to another, the trends show Americans paying a lot more than people in other countries for the same services.

Measuring how effectively we spend health care dollars is hugely complicated. But cross-national surveys offer some clues. We’re good at giving patients what they want — if they ask for it. So Americans can see a specialist or get elective surgery a lot faster than patients in other countries, according to surveys by the Commonwealth Fund. The surveys also show that Americans are more likely than people in other advanced nations to experience medical errors or problems with uncoordinated care, and to forgo care because it’s too expensive.

The O.E.C.D. report rates America at or near the top for survival rates in breast and colorectal cancer but slightly below average in cervical cancer. We rank in the middle of the pack in the percentage of heart attack patients who die in the hospital within 30 days of admission. And we have alarmingly high rates of hospital admissions for asthma and uncontrolled diabetes — an indicator that many patients don’t have good primary care, which can prevent costly hospital stays.