In the US, we spend much more on health care than other developed countries, but we have worse health outcomes — why? A new study in JAMA gives a detailed comparison of metrics from 11 high-income countries that challenges the conventional wisdom on what makes the U.S. healthcare system different.

The researchers found that key drivers of health care costs in the US compared to other high-income countries are prices and administrative costs. The US also ranks high in utilization of expensive imaging tests like MRIs and CT scans, and specific surgical procedures, like knee replacements and C-sections. However, patients in the US did not go to the doctor or hospital more than patients in other countries.