Yeah, I was just talking to an Italian girl who broke her wrist in the U.S. An American hospital charged her $1,000 for an x-ray that would have cost $20 in Italy.
Majority share of that is due to insurance companies currently. The way they mostly work these days is that the insurance company asks to see the hospitals Master Charge Record, the advertised prices of procedures, and then offers to pay pennies to the dollar based on it. Usually this is between 33-66%. They can do this because hospitals need to be able to accept those insurances or they don't get customers. So, whatever you see on the hospital bill, is actually two to three times what the hospital actually requires and actually gets for any procedure as any self payers are usually non-payers, so the only real source of revenue for hospitals is from insurance.
Then, since US hospitals are in direct competition with each other, they can't just have any old equipment. They need a newer and better x-ray machine than the other hospitals to convince doctors to send their patients to them. They also need newer and better rooms and care for so that the patients will have a good opinion of the hospital and go back. Hospitals are a service industry in the USA.
On top of all that, most hospital departments lose money. The usual big ones that bring in the money and pay for the rest of the hospital are surgery, pharmacy, and radiology because those are the big ticket items that usually aren't performed unless the money is there upfront.
That an X-ray is $20 in Italy, tells me that they are either using old equipment, lightly trained staff, or get significant subsidy from someplace like the government. The cost difference isn't that much between the euro and dollar and an X-ray is going to require attention of at least a doctor and probably an x-ray tech and a doctor, the cost of the machine, PACS system, dictation, RIS and EMR plus support contracts, the property of the hospital it takes up itself, plus all the support staff that come with it. Now it could be that she could end up in some country doctor's house with a broken foot and they pulled out their portable DR machine from a closet and x-rayed her foot on the kitchen table and they did all the paperwork themselves that night. I've heard stories of similar things happening to people I know in Europe without any report of lack of quality, as yes, things are different in Europe to the point that people in the US have a hard time imagining them.