Administrative complexity in the US health system has been identified as the source of enormous spending and potential cost savings. 1 In a new report, Sahni and colleagues 2 provided a detailed evaluation of administrative cost-savings opportunities, including an estimated $175 billion that could be addressed without new laws or regulatory changes.Health care is complicated because complexity is profitable. In the US health care system, payers, health systems, physicians, other clinicians, drug companies, pharmacies, and pharmacy benefit managers all earn more revenue because of administrative complexity. Moreover, unlike virtually any other sector of the economy, except higher education, health care can raise prices annually faster than inflation. 3 This means that revenues, margins, and profits can all improve without addressing administrative efficiency. In most other sectors, organizations can only improve margins if they improve labor productivity or simplify administration. 4 That administrative spending is greater in health care than other service industries is not new. Of the $3.8 trillion spent in 2019, an estimated $935 billion was on administrative spending. 1 This percentage, approximately 25%, has been roughly constant for more than a decade. 5 This Viewpoint explores the misaligned incentives that have made it difficult to make progress in reducing administrative spending and suggests potential changes necessary for administrative simplification to occur.
of 882 nurses aged 20 to 65 years were compared with 12,213 non-medical working women with similar socioeconomic status. Multivariate generalized estimating equation models were analyzed to test the hypotheses. We also used weighted propensity scores to adjust for selection bias. The primary outcomes were whether or not patients received hospital-based invasive procedures or surgery, total hospitalization cost, length of hospital stay (LOS), and 7-day and 14-day readmission association with genital diseases. Results: Nurses were less likely to undergo hospital-based surgery for genital diseases (OR 0.60; 95% CI: 0.44, 0.81), and they incurred lower total hospitalization cost (β -0.12; 95% CI: -0.18, -0.06) than non-medical working women after adjusting for demographic and clinical factors (eg, age, insurable wage, major diagnosis, Charlson comorbidity index, and physician and institutional characteristics). However, the likelihood of receiving hospital-based invasive procedures, longer LOS, and readmission did not differ between the two groups. ConClusions: A probability of undergoing hospitalized surgery for female genital diseases and incurring total hospitalization cost was lower among nurses than among non-medical working women. These findings suggest that medical knowledge, familiarity with health care system and care experience may have been contributory factors.
The United States (US) health care system spends an estimated $2500 per person per year on excess administrative costs that do not deliver clinical value. 1 Administrative costs are the largest source of waste, and attacking administrative inefficiencies has the benefit of having a low risk of unintentionally harming patient outcomes. 2 Billing and insurance-related costs are perhaps the most attractive area of potential savings. Many have proposed a single-
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.