Hagenaars Luc L, Klazinga Niek S, Mueller Michael, Morgan David J, Jeurissen Patrick P T
Celsus Academy for Sustainable Healthcare, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands.
Department of Social Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Int J Health Plann Manage. 2018 Jan;33(1):e263-e278. doi: 10.1002/hpm.2458. Epub 2017 Oct 12.
Administration is vital for health care. Its importance may increase as health care systems become more complex, but academic attention has remained minimal. We investigated trends in administrative expenditure across OECD countries, cross-country spending differences, spending differences between health care system typologies, and differences in the scale and scope of administrative functions across typologies.
We used OECD data, which include health system governance and financing-related administrative activities by regulators, governance bodies, and insurers (macrolevel), but exclude administrative expenditure by health care providers (mesolevel and microlevel).
We find that governance and financing-related administrative spending at the macrolevel has remained stable over the last decade at slightly over 3% of total health spending. Cross-country differences range from 1.3% of health spending in Iceland to 8.3% in the United States. Voluntary private health insurance bears much higher administrative costs than compulsory schemes in all countries. Among compulsory schemes, multiple payers exhibit significantly higher administrative spending than single payers. Among single-payer schemes, those where entitlements are based on residency have significantly lower administrative spending than those with single social health insurance, albeit with a small difference.
These differences can partially be explained because multi-payer and voluntary private health insurance schemes require additional administrative functions and enjoy less economies of scale. Studies in hospitals and primary care indicate similar differences in administrative costs across health system typologies at the mesolevel and microlevel of health care delivery, which warrants more research on total administrative costs at all the levels of health systems.
行政管理对医疗保健至关重要。随着医疗保健系统变得更加复杂，其重要性可能会增加，但学术关注仍然很少。我们调查了经合组织国家行政支出的趋势、国家间支出差异、医疗保健系统类型之间的支出差异，以及不同类型之间行政职能规模和范围的差异。
我们使用了经合组织的数据，其中包括监管机构、治理机构和保险公司在卫生系统治理和融资方面的行政活动（宏观层面），但不包括医疗保健提供者的行政支出（中观层面和微观层面）。
我们发现，在过去十年中，宏观层面与治理和融资相关的行政支出一直稳定在略高于卫生总支出的3%。国家间差异从冰岛卫生支出的1.3%到美国的8.3%不等。在所有国家，自愿私人医疗保险的行政成本都远高于强制保险计划。在强制保险计划中，多个支付者的行政支出明显高于单一支付者。在单一支付者计划中，基于居住权的计划的行政支出明显低于单一社会医疗保险计划，尽管差异很小。
这些差异部分可以解释为，多支付者和自愿私人医疗保险计划需要额外的行政职能，且规模经济效应较小。医院和初级保健方面的研究表明，在医疗保健提供的中观和微观层面，不同卫生系统类型在行政成本上也存在类似差异，这值得对卫生系统所有层面的总行政成本进行更多研究。
