>>On the other hand, the malpractice premiums that hospitals and doctors pay to the insurance (because lawyers have not control on how much they will look in settlements) greatly increase the cost of doing business in medical field.

While this is definitely true - check out what was happening in Texas before and after Proposition 12- you also need to compare expensive systems to cheaper systems in case there is another elephant in the room.

Apart from the obvious candidates, I would propose that a medical workforce that is motivated to get as much as possible from every $, is one of the very best ways to control costs. There was a time when "the diagnostician" who could observe a patient entering a room, take a history, conduct an exam and propose a small list of possible diagnoses to be distinguished by inexpensive tests, was a hero. These days the patient will be tested, irradiated, investigated and probed to the nth degree. Many patients perceive the over-testing as "quality" and your buddies the lawyers will attack a physician who leaves a test out, so medical practice devolves to ticking as many boxes as possible. Then manipulate medical income so that physicians rely on their cut from the tests to pay the school fees, and you have a vicious circle.