Who is taking care of the patients around here?

There is definitely something top heavy about the American Health care system. According to a recent article in Health Affairs by Himmelstein et al, which is summarized above in the Commonwealth Fund graphic, a quarter of all health care spending in the United States goes to administrative costs. The Health Affairs article points out that the trend is getting worse, “US hospital administrative costs rose from 23.5 percent of total hospital costs ($97.816 billion) in 2000 to 25.3 percent ($215.369 billion) in 2011. In the same period, the hospital administration share of GDP rose from 0.98 percent to 1.43 percent.”

Robert Kocher from the Harvard Business Review Blog, was able to explain what this looks like from a staff perspective in the hospital. Kocher writes:

“Using data from the Bureau of Labor Statistics (BLS) and the American Medical Association, my colleagues and I found that from 1990 to 2012, the number of workers in the U.S. health system grew by nearly 75%. Nearly 95% of this growth was in non-doctor workers, and the ratio of doctors to non-doctor workers shifted from 1:14 to 1:16.”

He continues, “Today, for every doctor, only 6 of the 16 non-doctor workers have clinical roles, including registered nurses, allied health professionals, aides, care coordinators, and medical assistants. Surprisingly, 10 of the 16 non-doctor workers are purely administrative and management staff, receptionists and information clerks, and office clerks. “

The numbers seems to confirm the feeling of many doctors that there are more people giving orders than taking care of patients.

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