To create a hospital in the US, most governments require that you have a certificate of need - and your eligibility is determined by those already running one. So existing hospitals can often gouge the fuck out of people. In many states, to offer almost any medical service, you need to be a full doctor with 7 years of school, but for a large number of medical needs, a nurse practitioner is more than enough. Most medical professionals in the USA are not allowed to advertise prices, hindering price competition. Most insurance companies are severely restricted in the areas they can compete, and can often not compete across state lines. Insurance companies are often required by law to cover a wide variety of electives and non essential medical procedures, even useless ones that are mostly cosmetic. Imports of generic medicines into the USA is severely restricted. FDA approval of allowed medicines in the USA, often costs over 100 million dollars, severely limiting new entrants and smaller competitors. Patents distort incentives in a free market (other western countries suffer from this problem too though, but many get around it by negotiating bulk deals with pharma companies). There are also tens of thousands of other regulations depending on your field of specialty, and area of medicine, some of these are useful and needed, but those who make the regulations often have close ties to the medical community, and financially benefit from regulations that limit competition, or make competition more expensive, as well.