Most all the world pays a marginal cost for drugs, medical devices, and procedures that does not come close to repaying the development effort that went into those products. Further, most of the world has regimented medical systems that have very strong immune systems against any sort of innovation.
As a result, almost all medical innovation occurs and is paid for in the United States, with the rest of the world acting as a free rider. Sure, some Swiss or Japanese firms still develop a few drugs, but most of those efforts are still justified by profits in the US market.
To this end, Megan McArdle had my favorite quote of the day:
we're still driving quite a bit of product innovation. Our messy, organic, wasteful, unfair, irrational system allows experimentation, and they [Europeans] cherry pick the best results. If we stopped doing this, their system would stop looking so good.
This is not to mention that the US tends to act as the capacity of last resort for desperate people in other countries who either can no longer tolerate the wait for a procedure or are not allowed by their country to have a certain procedure or drug.