Module 2 explores how high prices and intensive service use drive the cost of US healthcare. It examines differences in pricing for inpatient, outpatient, and pharmaceutical services, highlighting variations between private and public insurers. The module also explains that, even with fewer visits, each episode of care in the US is more service intensive—incorporating more complex and expensive treatments—compared to other countries.

Module 3 examines how the health systems in England and Germany are designed to control healthcare costs by influencing patterns of price and utilization. It explains how these countries use system dynamics—through governance, financing, resource generation, and service delivery—to set up defenses that contain high prices and excessive service use. The module explores the trade-offs and goals behind these designs, such as achieving universal coverage and the triple aim in England and using corporate self-governance to balance cost and access in Germany

Module 4 revisits the question of why US healthcare is so costly by examining the design features and systemic forces that limit cost containment. This module contrasts the US system’s open and fragmented boundaries with the more regulated frameworks of Germany and England. It analyzes how employer-sponsored insurance and Medicare employ market-based strategies, managed care, and cost sharing to control utilization—yet these approaches fall short of curbing high prices and the intensity of care within each episode. By focusing on the special protection of the doctor–patient relationship, the complexity of multiple financing streams, and the regulatory strategies in Medicare, the module demonstrates that despite efforts to limit care episodes, the US health system remains vulnerable to strong cost-driving forces. Ultimately, it challenges learners to consider whether the current high expenditure is the “least worst” outcome given these systemic constraints.