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Edited on Thu Dec-08-05 03:29 PM by Coastie for Truth
Canada's health care system ofers lower costs per capita by two steps-- 1. "Rationing" - which is what all of the Federalist Society and RWers and Neocons and Dr. Frist and Newt Gingrich seize on.
2. "Overhead" - Canada's system has much lower overhead - with different forms, billing clerks, 1-800 numbers in South Asia, PIN numbers, etc. All of that Administrative Overhead adds cost. References - Coastie gives you references
* Himmelstein DU, Woolhandler S, Wolfe SM., Administrative waste in the U.S. health care system in 2003: the cost to the nation, the states, and the District of Columbia, with state-specific estimates of potential savings. Int J Health Serv. 2004;34(1)-79-86.
* Woolhandler S, Campbell T, Himmelstein DU.. Health care administration in the United States and Canada: micromanagement, macro costs. Int J Health Serv. 2004;34(1)-65-78. Int J Health Serv. 2004;34(1):65-78. Related Articles, Links
Health care administration in the United States and Canada: micromanagement, macro costs.
Woolhandler S, Campbell T, Himmelstein DU.
Harvard Medical School, Cambridge, MA 02139, USA.
A decade ago, U.S. health administration costs greatly exceeded Canada's. Have the computerization of billing and the adoption of a more business-like approach to care cut administrative costs? For the United States and Canada, the authors calculated the 1999 administrative costs of health insurers, employers' health benefit programs, hospitals, practitioners' offices, nursing homes, and home care agencies; they analyzed published data, surveys of physicians, employment data, and detailed cost reports filed by hospitals, nursing homes, and home care agencies; they used census surveys to explore time trends in administrative employment in health care settings. Health administration costs totaled at least dollar 294.3 billion, dollar 1,059 per capita, in the United States vs. dollar 9.4 billion, dollar 307 per capita, in Canada. After exclusions, health administration accounted for 31.0 percent of U.S. health expenditures vs. 16.7 percent of Canadian. Canada's national health insurance program had an overhead of 1.3 percent, but overhead among Canada's private insurers was higher than in the U.S.: 13.2 vs. 11.7 percent. Providers' administrative costs were far lower in Canada. Between 1969 and 1999 administrative workers' share of the U.S. health labor force grew from 18.2 to 27.3 percent; in Canada it grew from 16.0 percent in 1971 to 19.1 percent in 1996. Reducing U.S. administrative costs to Canadian levels would save at least dollar 209 billion annually, enough to fund universal coverage.
* Woolhandler S, Campbell T, Himmelstein DU., Costs of health care administration in the United States and Canada. N Engl J Med. 2003 Aug 21;349(8)-768-75. Costs of health care administration in the United States and Canada.
N Engl J Med. 2003 Aug 21;349(8)-768-75.
Woolhandler S, Campbell T, Himmelstein DU.
Department of Medicine, Cambridge Hospital and Harvard Medical School, Cambridge, Mass, USA.
BACKGROUND: 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. METHODS: 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. RESULTS: 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.) CONCLUSIONS: 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. Copyright 2003 Massachusetts Medical Society
* Himmelstein DU, Woolhandler S.Perils of prediction in U.S./Canadian comparisons. Health Aff (Millwood). 1992 Winter;11(4):255-7
TAKE HOME AT THE END OF THE DAY: EVEN WITHOUT RATIONING - 30% OF THE COST OF US HEALTH CARE IS BUREAUCRACY, FRAUD, WASTE, ABUSE, DUPLICATION AND DEFENSIVE MEDICINE |
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