How Administrative Costs Drive Healthcare Costs
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- Опубліковано 27 сер 2018
- Administration of medical care is a huge driver of costs in the United States' healthcare system. Running hospitals, generating bills, and collecting payment are just a few of the activities that take up health providers' time, and run up the costs of care.
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I am a nurse who worked at the bedside for 15 years, then moved into a role where I worked more on the billing side. I couldn’t believe how much time and money is spent on the unseen part of medicine, all of the administrative costs. It changed my perspective on the benefits of a single payor system. We could save so much money off things were straight forward, instead of so convoluted.
yeah, I'm French and I went to the dentist in the US, that was crazy. 3 people behind the desk, then a parade in the room: hygienists, patient care coordinators (I think it's the salesperson, they do the quote), some dentists, all come with their assistant. I spent 2 hours at the dentist, saw a dozen of people, left without *any* care done (just exams) and a $1500 quote.
nraynaud1
Bonjour ;)
In Germany my dentist has 2-3 other assistance who are also doing at the same time the administration work.
And this is a praxis with 2 dentist so...
Last time I went to the dentist the dental assistant was also working reception. Being Australian is great, though we are slowly privatising our system which is making this kinda stuff worse.
For 24 days in the ICU, for just the bed, not the meds, not the surgery, not even the 24 hour nurse care, the hospital billed me $996,860. Aetna's member rate on this same bill was $28,523. WTF. 💙
Despite the frustrating topic, I really appreciate these videos! Thank you!
You are very well spoken and respectful! Thank you! You are refreshing! Good day
Glad this was addressed on your channel. Been waiting for it!
This is why I went to the surgery center of Oklahoma. No insurance, period. So much better.
Can you do a show on physician salary/benefits as a % of total healthcare expenditure? I haven't seemed to peg down a good number.
Zach Duarte it’s low man, around 10% I think.
Hey man thanks for this video.
Thank you for your piece in today's NYT re: the Metadata study on the dangers of alcohol. As usual, your comments brought clarity and some intellectual perspective to the argument.
And also take into consideration that the large portion of administrative costs is actually including health insurance administration. While this is part of US Healthcare, I would argue that they have developed into two separate industries. If you were to cut hospital and clinic administrative staff, good luck staying financially solvent / complying with best practices / implementing a QI department / improving patient experience. Physicians, nurses, and other careteam staffing are already overwhelmed with the intense acuity of their jobs.
So if there was a single-payer-like NHS and/or Medicare-for-all plan... the cost of American health care would unavoidably and eventually go down because administrative costs would be streamlined and consolidated? Then WHY do all the cost analysis of Senator Sanders' Medicare-for-all bills tend to assume CURRENT costs and CURRENT cost projections?
No, because government is not efficient.
You know that nations that have a privatized social security system pay hundreds of times more than what the United States does in administrative costs. You know why? Because it IS more efficient. Government is very good at being efficient.
This whole idea that government is wasteful and bumbling is right-wing and industry invention... its just not true... its why the USPS (United States Postal Service) is one of the best if not the best postal service in the world, the most trusted/respected federal agency, and it delivers far more and faster at cheaper rates despite the fact that it receives little if no funding from the US government.
And the fact of the matter is the USPS could be even more cost-effective, have more services, and deliver faster... if Congress would eliminate some regulations that prevents USPS from being more competitive. BUT the shipping industry OPPOSES lifting those regulations. You know why?
Nope. You're wrong. The private version of social security is called a fucking retirement account, and my retirement account has an administrative cost of .03% which isn't hundreds of times any government program. Government isn't efficient.
Nope, wrong again. The USPS had a monopoly over mail service for over a hundred years and was so bad in the early years that they had to shut down competition to stay going. Not that you'd care about that or it's other huge inefficiencies which you'd know if you actually talked to someone working there because fuck facts and fuck honesty. USPS is not the best postal service. You don't know what the fuck you're talking about. You're spewing left-wing bullshit like the rest.
The claim that government 'is never' efficient can be debunked just looking at the relative healthcare outcomes in Australia vs. the U.S., then looking at the relative costs to Government. You can compare it to half of Europe too. The public healthcare system (or hybrid system we have) out performs the highly privatised system in terms of quality of service, but most of all on price.
There certainly are government services that are run badly, but I think it comes down to two things: 1. Is it difficult or impossible to set up a healthy market? 2. Have you elected people who care about setting up a good system?
I'll leave point 2 for you to ponder, however Healthcare appears to be a bad place to apply market forces. People poorly estimate their need for healthcare, and in a lot of cases, they can't opt to reject the service if they don't think it's worth it. The services are easy to obfuscate and normal market abuse is amplified and can make people sicker, or at worst kill people.
Now in Australia we have medicare which insures everyone to a degree, but you can also get private insurance if you want. That private insurance is well regulated and has to compete with the public system. Our healthcare providers are a mix of public owned hospitals, and private operators. This mix has been leaning more private recently, and that has started making healthcare less efficient.
Markets are almost always excellent at distributing excess (food, clothes, entertainment, transport in a town). They are usually bad at distributing limited resources, or basic needs (water, power, healthcare, transport in a large city).
You know why. ;)
Obviously those on the right wanna vilify it, but I think those on the left would like to see quality of healthcare improve. So they don't focus on the money saving aspect.
Since the insurance industry highjacked healthcare, hospital CEO's have been devising strategies to stay afloat. The energy in hospitals has gone from the patient to revenue opportunities. It would be really interesting if one could calculate how much energy and money are devoted to patient care vs making money. Allowing a third party to call the shots is a really bad idea, and I'm not optimistic that healthcare professionals can retake the hill.
Are administrative costs also responsible for the huge cost of childbirth? I know the money isn't going to the care of mothers in the U.S.
Hospitals are Westin Hotel prices with Motel 6 service, at least you get your monies worth at the fancy hotels.
I like the new intro
I think this video underestimates the impact of the administrative burden on health care. I'm an ER doctor. I am not exaggerating when I say that 70 percent of my time is spent sitting in front of a computer documenting various aspects of the patient encounter. This is true even with the new, supposedly more efficient, electronic medical records systems (EMRs) like EPIC and Cerner. In fact, we now document more because we can. The hospital doesn't want to miss a single dime of potential revenue so now everybody including doctors and nurses spend most of their time on typing or dictating into EMRs which are mostly billing systems. Even a simple visit...a sore throat...generates a 12-page chart and endless boilerplate, much of it robotic. The actual useful content of most charts for most patients could be summarized in one succinct paragraph.
What this means is that there is no real doctor or nursing shortage. If paperwork disappeared today you would see a sudden at least doubling of capacity. This is how much of our time is dissipated. People who are not in health care don't realize this...or you do when you notice your doctor seems to spend your entire visit typing on her laptop.
Modern American health care is the most ridiculous enterprise in the history of the world. It will take a large, planet-killing meteor to fix it.
No other business gets to operate like healthcare. I had about a 20 hour period of my life cost me $20,000. An hour and half of that was spent driving myself between hospitals and about 17 hours where spent in a recovery room sleeping by myself. That's $1000 an hour.....that's absolutely outrages! I had my appendix removed, the actual surgery itself took less then 20 mins and went smoothly.
Ha ha. It's crazy. It's the same in the ER. I might spend five minutes with a patient for a relatively minor complaint. The nurse might spend the same amount of time doing their legitimate nursing functions. Then we'll both have to document on the EMR for 15 minutes. A train of clerks will see the patient and have them sign reams of forms, mostly disclaimers, and you'll get a bill for $5000.
So not having free healthcare makes you pare more taxes? God Bless America indeed
The "I happened to look at my subs when it was uploaded" club
At least you're looking at your subs. People just click on whatever is on the front page and then youtubers get mad for being suppressed. We need to train more people to look at their subs.
Most admin personnel get paid more than techs nurses and personnel who provide direct patient care. Health care is not a good field to get into now a days
We’ve got too many people getting their Masters Degrees in Healthcare Administration or even more generic MBAs.
CC CC how else can you sit behind a desk, raking numbers on excel and call yourself influential
The fact that administrative costs are so high would seem to suggest that if we could engineer the proper incentives into the system there could be a lot of cost reduction even while maintaining the same quality of care
Same with education.
Myriad choices? What are those? The choice of no insurance or terrible insurance? Oh right.
BIG deal that never gets brought up when discussing USA health politics. Keep preachin!!!
This raised some questions that I'd like to ask.
Does the US's high spending on administration correlate with a better administrative system?
Other than single payer, what are potential avenues to decrease rising administrative costs?
You can't compare the administrative systems because their goals are different.
In canada the administrative system's job is to pay and support the medical staff and purchase supplies.
In the states, the administrative system's job is that, plus collect money from insurers and patients.
If being good means creating a lot of jobs with people with an MBA then the states model is good. If being good means not creating costs for the patient than the states model is terrible.
And you could decrease administrative costs by not providing healthcare altogether, or by refusing to call the insurer and demanding to be payed in full by the patient, and have them mail the bill to their insurers. It's good for the insurer too because a lot of patients typically don't have the literacy and technical skills to communicate with their insurer.
He said it in the video. A good portion of the rising costs of administration is going towards dealing with the increasingly complex paperwork (billing) of insurance. Each provider wants different forms, uses a different software, etc
When there is more chiefs than indians nothing gets done properly.
Stay away from any enterprise than does not respect the 1:7 administrator to worker ratio rule.
Voila
TheGreen Jarret I've never heard of it that way before, but it makes sense.
Oh god, my university really is screwed! My department is more like 1:2
As someone who's done some medical billing, this doesn't surprise me at all. Everyone wants the same information pushed through non-compatible, decrepit, borderline unsupported pipelines in conflicting formats. It's basically the cellphone charger wars, except in that case consumers actually had some influence over the result.
Average of $19,000!! I am a retired UK resident, when I was working I was earning about $51,500. National insurance cost me about $5,000 pa. That contributed to theNational health service, State Pension and unemployment benefit. That also covered my wife and children, and if I'd lost my job, which I never did, we would still have been fully covered.
Now I'm retired I no longer have to pay N.I. but am still entitled to the same health care,
no co-pay, no deductibles, no prior condition exclusions. Treatment is free at the point of treatment.
I am amazed you Americans think this is some kind of socialist, liberal plot to increase your taxes. Yes you'd pay more tax, but a lot less than the cost of crappy private insurance!!
Why do college guys like bagel bites so much? 0:23
What is not understood in the United States is that government "accountability" is another word for paperwork that does not ever result in better services or savings. In an attempt to catch bad actors accountability paperwork is generated that mostly catches the good people in red tape. It is also generated at the chance the institute is sued. This type of paperwork often baffles the consumer or it is ignored. The time and money spent on these measures are never factored into the calculations of efficiency or savings on catching the bad actors. Very inefficient and makes most people crazy.
*Laughs in european*
*Cries in american*
*Politely Chuckles in Canadian*
*Cracks up in Australian*
Bahaha best set of comments 😂
This is what happens when you leave healthcare to the private market aka the cabal of robber barons. Single payer should streamline the system and reduce the cost dramatically.
It would everywhere else but the United States. I guarantee that whatever system we eventually adopt to fix the problems will be so influenced by lobbyists that it will be just as bad, if not worse. This video doesn't even cover the cost of malpractice and defensive medicine. I'm sure we will never fix that problem. It will take a planet-killing meteor strike to fix our system. Ever been to the VA? They're administrative overhead is significant and they have layer upon layer of bureaucrats.
It'll be better when we get Epic. I hear it doesn't crash. Cue sarcastic laughter
I have a funny story about Epic. A few years ago my mom was staying in a hospital that was switching its EHR system over to Epic. I asked a nurse how it was going. She replied, it's taking some time to get used to it but it's going pretty well.
Later, I walked into a lounge and on the blackboard was written was how to respond to people who ask how the change in EHR is going: Tell them, "It's taking some time to get used to it but it's going pretty well."
a large part of high cost of healthcare are ambulance chasing lawyers..always ready for the next lawsuit so who is paying for the high premiums for malpractice insurance?.. we all do..doctors and hospitals are forced to pass this cost along to the patient so the next time you complain about your medical bills thank a lawyer
Studies of tort reform say it is not such a large part.
*NOT* First
Tasurincci - at anything
Clever Girl
okay but let's talk about medical staffing costs lol
There was once a time when administrative costs weren't so high- back when all physicians were okay with making a salary similar to today's PCPs. Once the Docs realized more charges are reimbursed when someone is able to dedicate 40 a hours a week to making sure its billed correctly, they were the ones to initiate this administrative cost shifting by becoming overly specialized.. and please don't act like physicians actually do their own billing, no Doctor would choose to work somewhere that held Doctors responsible for their entire billing process.. Surgeons would literally kill themselves if they had to waste a second of their self professed "Godly powers" on billing and reimbursement, even if their overall reimbursement led to a drop in their salary... then they'd just choose to hire administrative staff.. can't get around it unless you change the medical education and specialization system or American healthcare reimbursement as a whole.
Easy now. Administrative costs are built into the system. I'm an ER doctor. I spend 70 percent of my time sitting in front of a computer and I'm known as something of a maverick....I get my charts done during the shift instead of staying late and finishing them for free on my own time like many of my idiotic colleagues whose free labor keeps the system afloat.
I often point out that if doctors and nurses wanted to shut the health system down they would diligently follow every rule, document everything according to the rule, and cut no corners on bureaucratic tasks...which we do now or we'd never get any real work done. This reminds me of a patient I had who insisted on reading every one of the large number of forms he was asked to sign before his visit. Nobody ever reads them, of course, because it's all pro forma bullshit. But if nobody reads them and they serve no purpose, why have them at all?
But that's Stupid Age America for you. A dying nation in rapid decline. I admired that patient even though he was pissing everybody else off. What were they going to say to him? That he wasn't allowed to read the forms. And he refused, on legitimate grounds, to sign a coupe of them. Heads exploded. He was my favorite patient of all time.
M4A is the future
do a video on how to increase your sperm count, healthcare triage
Absolutely love the show, and actually surprised you covered this topic at all. Of course though you don't mention anything at all about the healthcare industry being required by law to have all this administration costs because that would force you to admit deregulation would save massive amounts of money and you would never support that. But hey this is still a baby step in the right direction. At least you do acknowledge it is a problem. But actually thinking physicians want to have all this administration cost is completely crazy. I can assure you if they didn't HAVE to do it, they wouldn't. But since healthcare is regulated out the wazoo, it is required by the healthcare industry to spend so much time and money on administration so they don't get sued or miss one of the 50,000,000 laws associated with healthcare.
Ronnie Girardot It's not physicians causing the administrative costs, it's the insurance companies. If regulation were the problem, we wouldn't have the highest administrative costs in the world since we are not the most regulated at all.
Kevin Allen did you even read my post? Did you even read your post before you submitted it? I am not sure who you are talking to but I rather certain you aren't even actually speaking to me
Ronnie Girardot You claimed that it's regulation forcing doctors to have lots of administration costs because of regulation, but Canada has more regulations while still having fewer administrative costs, so that isn't true.
Dr. Carroll clearly makes the point that the administrative costs are mostly the result of the complexity of the system of administering among dozens of different insurers. Which has nothing to do with regulation.
Let's just go right ahead and have a single payer to minimize the administrative costs.
And annihilate... what, 1.5% of the total GDP which is dedicated to non-useful tasks... mostly by women... mostly by low middle class workers.
It's interesting to see that you americans have a whole section of your economy dedicated to something so pointless.
What a fucking mess
Hi if you�re reading this. Please remember you�re beautiful , I hope you are having a wonderful day!
So single payer could help save millions in administration costs...
No, because government is not efficient.
Yup. It's almost like standardization leads to more efficient processes.
James, why are the Canadian system's administrative costs so much lower if private insurers are so much more efficient than the government?
Because the US still has government involvement in the form of a regulatory hellscape.
I have to agree that the US has uniquely incompetent government. But... Republicans. What can you do?
So you're saying that we should get government out of healthcare since government is administration, right? RIGHT??
Nope. No mention of cash business or direct primary care whatsoever because you gotta shill a bit harder for "muh single payer." It's a simple solution and you didn't look for any research on this, did you?
James Adams Damn dude. How old are you? No need to throw a hissy fit on a medical channel
Did you actually listen to the video? It doesn't seem like it.
James Adams I hope you're not older than 21. I'd hate to see an adult act like a spoiled brat like this in real life. This video owes you nothing. No need to throw a fit
Cash business and direct primary sound like things poor people can't access in a capitalist system, but also that the government could run too to eliminate costs.
Complying w a million idiotic government regulations is the driver of administration costs for both healthcare providers & insurance companies alike. This guy is very bias and small minded.
A lot of those billing administration costs come from every company having their own form and submission process and basically refusing to support either those processes or any form of standardization, and from insurance companies intentionally fucking with providers so they don't have to pay out. But sure, blame HIPAA.