Woolhandler Steffie, Campbell Terry, Himmelstein David U
Department of Medicine, Cambridge Hospital and Harvard Medical School, Cambridge, Mass, USA.
N Engl J Med. 2003 Aug 21;349(8):768-75. doi: 10.1056/NEJMsa022033.
A decade ago, the administrative costs of health care in the United States greatly exceeded those in Canada. We investigated whether the ascendancy of computerization, managed care, and the adoption of more businesslike approaches to health care have decreased administrative costs.
For the United States and Canada, we calculated the administrative costs of health insurers, employers' health benefit programs, hospitals, practitioners' offices, nursing homes, and home care agencies in 1999. We analyzed published data, surveys of physicians, employment data, and detailed cost reports filed by hospitals, nursing homes, and home care agencies. In calculating the administrative share of health care spending, we excluded retail pharmacy sales and a few other categories for which data on administrative costs were unavailable. We used census surveys to explore trends over time in administrative employment in health care settings. Costs are reported in U.S. dollars.
In 1999, health administration costs totaled at least 294.3 billion dollars in the United States, or 1,059 dollars per capita, as compared with 307 dollars per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada. Canada's national health insurance program had overhead of 1.3 percent; the overhead among Canada's private insurers was higher than that in the United States (13.2 percent vs. 11.7 percent). Providers' administrative costs were far lower in Canada. Between 1969 and 1999, the share of the U.S. health care labor force accounted for by administrative workers grew from 18.2 percent to 27.3 percent. In Canada, it grew from 16.0 percent in 1971 to 19.1 percent in 1996. (Both nations' figures exclude insurance-industry personnel.)
The gap between U.S. and Canadian spending on health care administration has grown to 752 dollars per capita. A large sum might be saved in the United States if administrative costs could be trimmed by implementing a Canadian-style health care system.
十年前，美国医疗保健的行政管理成本大大超过加拿大。我们调查了计算机化、管理式医疗的兴起以及采用更具商业风格的医疗保健方式是否降低了行政管理成本。
我们计算了1999年美国和加拿大健康保险公司、雇主的健康福利计划、医院、医生办公室、疗养院和家庭护理机构的行政管理成本。我们分析了已发表的数据、医生调查、就业数据以及医院、疗养院和家庭护理机构提交的详细成本报告。在计算医疗保健支出的行政管理份额时，我们排除了零售药店销售额和其他一些无法获取行政管理成本数据的类别。我们使用人口普查调查来探究医疗保健机构行政管理就业随时间的趋势。成本以美元报告。
1999年，美国医疗行政管理成本总计至少2943亿美元，人均1059美元，而加拿大人均为307美元。排除相关因素后，行政管理在美国医疗保健支出中占31.0%，在加拿大占16.7%。加拿大的国家医疗保险计划管理费为1.3%；加拿大私人保险公司的管理费高于美国（13.2%对11.7%）。加拿大医疗服务提供者的行政管理成本要低得多。1969年至1999年期间，美国医疗保健劳动力中行政人员所占比例从18.2%增至27.3%。在加拿大，该比例从1971年的16.0%增至1996年的19.1%。（两国数据均不包括保险业人员。）
美国和加拿大在医疗保健行政管理支出上的差距已扩大到人均752美元。如果美国能够通过实施加拿大式医疗保健系统来削减行政管理成本，可能会节省一大笔资金。
