Kinder- und Jugendmedizin
01 Aug 2021-Vol. 20, Iss: 01, pp 3-3
About: The article was published on 2021-08-01. It has received None citations till now.
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TL;DR: The gap between U.S. and Canadian spending on health care administration has grown to 752 dollars per capita, and a large sum might be saved in the United States if administrative costs could be trimmed by implementing a Canadian-style health care system.
Abstract: 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 in the United States, or $1,059 per capita, as compared with $307 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 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.
588 citations
TL;DR: Investor-owned nursing homes provide worse care and less nursing care than do not-for-profit or public homes.
Abstract: Objectives. Two thirds of nursing homes are investor owned. This study examined whether investor ownership affects quality. Methods. We analyzed 1998 data from state inspections of 13 693 nursing facilities. We used a multivariate model and controlled for case mix, facility characteristics, and location. Results. Investor-owned facilities averaged 5.89 deficiencies per home, 46.5% higher than nonprofit facilities and 43.0% higher than public facilities. In multivariate analysis, investor ownership predicted 0.679 additional deficiencies per home; chain ownership predicted an additional 0.633 deficiencies. Nurse staffing was lower at investor-owned nursing homes. Conclusions. Investor-owned nursing homes provide worse care and less nursing care than do not-for-profit or public homes.
294 citations
Journal Article•
TL;DR: A systematic review and meta-analysis of studies comparing the mortality rates of private for- Profit hospitals and those of private not-for-profit hospitals suggests that private for the-profit ownership of hospitals, in comparison with private not thefor-profits ownership, results in a higher risk of death for patients.
Abstract: Background: Canadians are engaged in an intense debate about the relative merits of private for-profit versus private not-for-profit health care delivery. To inform this debate, we undertook a systematic review and meta-analysis of studies comparing the mortality rates of private for-profit hospitals and those of private not-for-profit hospitals. Methods: We identified studies through an electronic search of 11 bibliographical databases, our own files, consultation with experts, reference lists, PubMed and SciSearch. We masked the study results before determining study eligibility. Our eligibility criteria included observational studies or randomized controlled trials that compared private for-profit and private not-for-profit hospitals. We excluded studies that evaluated mortality rates in hospitals with a particular profit status that subsequently converted to the other profit status. For each study, we calculated a relative risk of mortality for private for-profit hospitals relative to private not-for-profit hospitals and pooled the studies of adult populations that included adjustment for potential confounders (e.g., teaching status, severity of illness) using a random effects model. Results: Fifteen observational studies, involving more than 26 000 hospitals and 38 million patients, fulfilled the eligibility criteria. In the studies of adult populations, with adjustment for potential confounders, private for-profit hospitals were associated with an increased risk of death (relative risk [RR] 1.020, 95% confidence interval [CI] 1.003–1.038; p = 0.02). The one perinatal study with adjustment for potential confounders also showed an increased risk of death in private for-profit hospitals (RR 1.095, 95% CI 1.050–1.141; p < 0.0001). Interpretation: Our meta-analysis suggests that private for-profit ownership of hospitals, in comparison with private not-for-profit ownership, results in a higher risk of death for patients.
276 citations
TL;DR: Administrative costs as a percentage of total hospital costs increased in the United States between 1990 and 1994 and were particularly high at for-profit hospitals.
Abstract: Background In fiscal year 1990, administration accounted for 24.8 percent of total hospital costs in the United States — nearly twice the share in Canada. Studies from the 1970s and early 1980s found high costs, especially for administration, at for-profit hospitals. Methods We calculated administrative costs for 6227 nonfederal hospitals and the total costs of inpatient care for 5201 acute care hospitals in the United States for fiscal year 1994 on the basis of data the hospitals submitted to Medicare. We analyzed similar data for fiscal year 1990. Using multivariate analysis, we assessed the effect of hospital ownership (private not-for-profit, for-profit, and public) on administrative costs, controlling for hospital type, census region, hospital size, and the proportion of revenues derived from outpatient services. We adjusted inpatient costs for local wage levels, hospitals' reporting periods, and case mix. Results Administrative costs accounted for an average of 26.0 percent of total hospital costs i...
220 citations
TL;DR: Investor-owned HMOs deliver lower quality of care than not-for-profit plans, and investor ownership was consistently associated with lower quality after controlling for model type, geographic region, and the method each HMO used to collect data.
Abstract: Context The proportion of health maintenance organization (HMO) members enrolled
in investor-owned plans has increased sharply, yet little is known about the
quality of these plans compared with not-for-profit HMOs. Objective To compare quality-of-care measures for investor-owned and not-for-profit
HMOs. Design, Setting, and Participants Analysis of the Health Plan Employer Data and Information Set (HEDIS)
Version 3.0 from the National Committee for Quality Assurance's Quality Compass
1997, which included 1996 quality-of-care data for 329 HMO plans (248 investor-owned
and 81 not-for-profit), representing 56% of the total HMO enrollment in the
United States. Main Outcome Measures Rates for 14 HEDIS quality-of-care indicators. Results Compared with not-for-profit HMOs, investor-owned plans had lower rates
for all 14 quality-of-care indicators. Among patients discharged from the
hospital after myocardial infarction, 59.2% of members in investor-owned HMOs
vs 70.6% in not-for-profit plans received a β-blocker (
P<.001); 35.1% of patients with diabetes mellitus in investor-owned
plans vs 47.9% in not-for-profit plans had annual eye examinations (P<.001). Investor-owned plans had lower rates than not-for-profit
plans of immunization (63.9% vs 72.3%; P<.001),
mammography (69.4% vs 75.1%; P<.001), Papanicolaou
tests (69.2% vs 77.1%; P<.001), and psychiatric
hospitalization (70.5% vs 77.1%; P<.001). Quality
scores were highest for staff- and group-model HMOs. In multivariate analyses,
investor ownership was consistently associated with lower quality after controlling
for model type, geographic region, and the method each HMO used to collect
data. Conclusions Investor-owned HMOs deliver lower quality of care than not-for-profit
plans.
219 citations