Woolhandler S, Himmelstein D U
Department of Medicine, Cambridge Hospital, Mass.
N Engl J Med. 1991 May 2;324(18):1253-8. doi: 10.1056/NEJM199105023241805.
In 1983 the proportion of health care expenditures consumed by administration in the United States was 60 percent higher than in Canada and 97 percent higher than in Britain. To assess the effects of recent health policy initiatives on the administrative efficiency of health care, we examined four components of administrative costs in the United States and Canada for 1987: insurance overhead, hospital administration, nursing home administration, and physicians' billing and overhead expenses. Most data were provided by the two nations' federal health and statistics agencies, supplemented by state and provincial data and published sources. Because data on physicians' billing costs were limited, we estimated a range for these costs by two methods that rely on different sources of data. All figures are reported in 1987 U.S. dollars.
In 1987 health care administration cost between $96.8 billion and $120.4 billion in the United States, amounting to 19.3 to 24.1 percent of total spending on health care, or $400 to $497 per capita. In Canada, between 8.4 and 11.1 percent of health care spending ($117 to $156 per capita) was devoted to administration. Administrative costs in the United States increased 37 percent in real dollars between 1983 and 1987, whereas in Canada they declined. The proportion of health care spending consumed by administration is now at least 117 percent higher in the United States than in Canada and accounts for about half the total difference in health care spending between the two nations. If health care administration in the United States had been as efficient as in Canada, $69.0 billion to $83.2 billion would have been saved in 1987.
The administrative structure of the U.S. health care system is increasingly inefficient as compared with that of Canada's national health program. Recent health policies with the avowed goal of improving the efficiency of care have imposed substantial new bureaucratic costs and burdens.
1983年，美国医疗保健支出中行政管理所占的比例比加拿大高60%，比英国高97%。为评估近期卫生政策举措对医疗保健行政效率的影响，我们研究了1987年美国和加拿大行政成本的四个组成部分：保险间接费用、医院管理、疗养院管理以及医生计费与间接费用。大部分数据由两国的联邦卫生与统计机构提供，并辅以州和省的数据以及公开资料。由于医生计费成本的数据有限，我们通过两种依赖不同数据来源的方法估算了这些成本的范围。所有数据均以1987年的美元报告。
1987年，美国医疗保健行政管理成本在968亿美元至1204亿美元之间，占医疗保健总支出的19.3%至24.1%，即人均400美元至497美元。在加拿大，8.4%至11.1%的医疗保健支出（人均117美元至156美元）用于行政管理。1983年至1987年期间，美国的行政成本实际增长了37%，而加拿大的行政成本则有所下降。目前，美国医疗保健支出中行政管理所占的比例比加拿大至少高117%，约占两国医疗保健支出总差异的一半。如果美国的医疗保健行政管理能像加拿大那样高效，1987年将节省690亿美元至832亿美元。
与加拿大的国家医疗保健计划相比，美国医疗保健系统的行政结构效率越来越低。近期那些宣称旨在提高医疗效率的卫生政策带来了大量新的官僚成本和负担。
