I am from India. I think one major cost factor is price of medicine. In India, you can get medicine at very low cost compared to the west. Salary and dollar conversion/PPP are also major cost factors. For instance, a urine test costs $1-$1.5 in India, urine culture is about $6, a USG scan is about $14. In USA, urine routine is $30, culture is $70 and USG is $750