Ok when it comes to the U.S. Healthcare system, the insurance companies decide who gets paid what. Here is what happens. A doctor will perform a test or procedure. They then file with the insurance company for X amount in compensation. Then the insurance companies basically say that is too much we are going to pay you x amount. That is why are healthcare system needs fixing. Doctors don't want to take these costs, so they pass them onto the patient. That is why our healthcare is so expensive.