- David U. Himmelstein ( [email protected] ) is an internist; a professor at the School of Public Health and Hunter College, City University of New York (CUNY), in New York City; and a lecturer at Harvard Medical School.
- Miraya Jun was a research officer at the London School of Economics and Political Science (LSE), in the United Kingdom, at the time of this study. She is now an independent consultant to the LSE.
- Reinhard Busse is a professor of health care management at the Technische Universität Berlin–World Health Organization Collaborating Centre for Health Systems Research and Management, in Berlin, Germany.
- Karine Chevreul is the deputy director of the Paris Health Services and Health Economics Research Unit at the Assistance Publique–Hôpitaux de Paris (the Paris area’s University Medical Center) and deputy director of ECEVE (UMR 1123), a research team of the French National Institute of Medical Research, in Paris, France.
- Alexander Geissler is a senior research fellow in health care management at the Technische Universität Berlin, in Germany.
- Patrick Jeurissen is head of the Celsus Academy on Sustainable Healthcare, Nijmegen Medical Centre, Radboud University, in Nijmegen, the Netherlands.
- Sarah Thomson is an associate professor in the Department of Social Policy, London School of Economics, and a senior research associate at the European Observatory on Health Systems and Policies, in London, England.
- Marie-Amelie Vinet is a health economist at the Paris Health Services and Health Economics Research Unit at the Assistance Publique–Hôpitaux de Paris and also a member of the ECEVE team (UMR 1123) of the French National Institute of Medical Research.
- Steffie Woolhandler is an internist; a professor at the School of Public Health and Hunter College, CUNY; and a lecturer at Harvard Medical School.
A few studies have noted the outsize administrative costs of US hospitals, but no research has compared these costs across multiple nations with various types of health care systems. We assembled a team of international health policy experts to conduct just such a challenging analysis of hospital administrative costs across eight nations: Canada, England, Scotland, Wales, France, Germany, the Netherlands, and the United States. We found that administrative costs accounted for 25.3 percent of total US hospital expenditures—a percentage that is increasing. Next highest were the Netherlands (19.8 percent) and England (15.5 percent), both of which are transitioning to market-oriented payment systems. Scotland and Canada, whose single-payer systems pay hospitals global operating budgets, with separate grants for capital, had the lowest administrative costs. Costs were intermediate in France and Germany (which bill per patient but pay separately for capital projects) and in Wales. Reducing US per capita spending for hospital administration to Scottish or Canadian levels would have saved more than $150 billion in 2011. This study suggests that the reduction of US administrative costs would best be accomplished through the use of a simpler and less market-oriented payment scheme.