The Deteriorating Administrative Efficiency of the U.S. Health Care System

Woolhandler, Steffie; Himmelstein, David U.

doi:10.1056/nejm199105023241805

Cited by 318 publications

(86 citation statements)

References 7 publications

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“…However, no mention of this additional utilization is found in the article that spawned this controversy. 10 It is unrealistic of the authors to have expected policymakers to review their bibliography to gain proper perspective on their work.…”

Section: Return To Constructive Debate O N Us/canadian Health Spendingmentioning

confidence: 99%

Return To Constructive Debate On U.S./Canadian Health Spending

1992

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Section: Return To Constructive Debate O N Us/canadian Health Spendingmentioning

confidence: 99%

Return To Constructive Debate On U.S./Canadian Health Spending

1992

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“…Government financing of health care would have substantially reduced administrative waste and transaction costs (41,42). The emphasis on primary care and prevention would have reduced some costs and helped to attain better outcomes.…”

Section: The 1993-1994 Health Care Reform Debate Revisitedmentioning

confidence: 99%

Economic Boundaries of Health Policy: Factors Influencing 1993–1994 Reform Proposals

Nayeri

1996

Int J Health Serv

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This article offers a theoretical framework for understanding the crisis of the U.S. health care system and the mainstream debate on restructuring health care financing and delivery subsystems. The author argues that the crisis of the health care system is a cause and a consequence of the long cycle of structural changes in the U.S. economy since World War II. The article distinguishes between the level and the rate of growth of health care expenditures. It is possible to moderate the level of health care expenditure by adopting measures in the direction indicated by the historical experience of other advanced capitalist economics. However, in the long term the rate of growth of health care costs will exceed the rate of growth of gross domestic product, thus any attempt to limit it will result in deterioration in the quantity and quality of health care services. The 1993-1994 mainstream debate is revisited to show how these proposals were a part of the overall effort to resolve the long-term problems of the U.S. economy. The defeat of the Clinton plan was due to its concerns with efficiency of the health care system in the face of the demand by a majority of the U.S. capitalist class to cut costs.

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“…With profits highly dependent on the underwriting cycle, it is difficult to estimate changes in insurance-related administrative costs using the NHA figure (60). To estimate administrative costs in hospitals, researchers have primarily used annual cost reports that hospitals submit to Medicare (69,79,80). Estimates of administrative costs of physician offices are more difficult to obtain and have been based either on physician self-reported professional expenses or the number of employees in the office (79 (79).…”

Section: Administrative Overheadmentioning

confidence: 99%

What's Behind the Health Expenditure Trends?

Mehrotra¹,

Dudley²,

Luft³

2003

Annu. Rev. Public Health

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In this paper, we review the literature on a number of the potential explanations for the rise in health care expenditures in the United States: the aging population, the costs of dying, technology, physician incomes, administrative costs, prescription drugs, managed care, and the underfunding of public health. Our goal is not to pass definitive judgment on the force(s) driving health care costs, but rather to make the reader a more educated consumer of these widely cited data. We place special emphasis on how health expenditures are measured and the inherent weaknesses in the methodology. We find that frequently it is difficult to accurately estimate how individual forces influence total health care expenditures. Moreover, we conclude that interpreting the causes of the rise in expenditures goes beyond simple observations of trends and depends on how we value various segments and aspects of health and health care. INTRODUCTIONDespite years of concern and attempts at cost control, the nation's health care expenditures have grown inexorably. We hear of health care costs "spiraling out of control," the health care "crisis," and how government, employers, and the uninsured struggle to find ways to pay the bills. Heated discussions on the underlying reasons for the rise in health expenditures have been a fixture of news and public policy debates for over 40 years. The most recent explanation is that pharmaceuticals are driving the rise in health care expenditures and this is secondary to direct-to-consumer advertising and excessive profit making by the pharmaceutical industry. Over the years, other factors have been blamed, including excessive administrative costs, the aging population, the use of high-technology care, and excessively high physician incomes. There is also much debate about whether managed care controlled health care expenditures and, if so, was it a lasting effect? These discussions often focus on a single factor and there is little literature that synthesizes the debate on these factors. 386MEHROTRA DUDLEY LUFTIn this paper we attempt to do just that: We review the literature on the major factors thought to influence the nation's health care expenditures. Our goal is not to pass definitive judgment on the force(s) driving health care costs (we think it an impossible task), but rather to allow the reader to be a more educated consumer of these widely cited data, separating rhetoric from fact. To better understand the controversies at hand, we place special emphasis on how health expenditures are measured and the weaknesses (and sometimes biases) inherent in the methodologies used.The paper begins with background on what underlies the concern with increasing health care expenditures. We then briefly discuss how total expenditures are measured and give an overview of spending. The majority of the paper is then devoted to eight commonly cited factors thought to influence the nation's health care expenditures. We conclude with our thoughts on how to interpret the debate.

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The Deteriorating Administrative Efficiency of the U.S. Health Care System

Abstract: 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.

Cited by 318 publications

References 7 publications

Return To Constructive Debate On U.S./Canadian Health Spending

Return To Constructive Debate On U.S./Canadian Health Spending

Economic Boundaries of Health Policy: Factors Influencing 1993–1994 Reform Proposals

What's Behind the Health Expenditure Trends?

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