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Combining the two links, it looks like this: > I'll try to describe it in a different way. In the link that I provided, the US pays (on average) $8,021 per cap

Combining the two links, it looks like this: > I'll try to describe it in a different way. In the link that I provided, the US pays (on average) $8,021 per capita on non-admin costs, while peer countries pay $3,602 per capita on non-admin costs. Even accounting for the fact that 25% of a hospital's revenue is administrative, it 1) is not at all the case that admin costs are in the same ballpark as the difference between the two ($4,500 per person), 2) doesn't do much to bridge the non-admin gap, which forms the lion's share of the cost difference, since if you zero out the admin costs, even the costs that provider offices pay (25% of their total revenue), you're still left with the fact that the US pays over 2x peer countries. Isn't a useful analysis. The admin costs in the US are roughly $937 + ($8,021 * 0.25) = $2942.25—and possibly worse, depending on how much of the stuff from other categories might fall under "hospital budget", though that may be evened out by the difference between budget and revenue (which is the biggest unknown factor here, trying to combine the info from the two links). Hospital admin costs in comparable states seems to be 20% in the worst case plus that $201 of non-hospital admin costs. Worst case, $201 + ($3,602 * 0.20) = $921.40 How is that not a very large part of the difference in costs? It looks like ~40% of the difference in total per capita spending, in fact. I'm sure that's a little off, but where am I going wrong that allows it to become negligible in your analysis?

bhupy 5y ago
> The admin costs in the US are roughly $937 + ($8,021 * 0.25) = $2942.25—and possibly worse, depending on how much of the stuff from other categories might fall under "hospital budget", though that may be evened out by the difference between budget and revenue (which is the biggest unknown factor here, trying to combine the info from the two links). This is incorrect, the inpatient and outpatient costs do not include the hospital admin fees. That figure only includes the fee-schedule payments per procedure. The fee-for-service model makes it rather easy to isolate that amount. That's why your statement here: > How is that not a very large part of the difference in costs? It looks like ~40% of the difference in total per capita spending, in fact. I'm sure that's a little off, but where am I going wrong that allows it to become negligible in your analysis? doesn't quite make sense. You can't take that 25% and apply t against the in-patient and out-patient costs, because it's not at all clear that it fits into that bucket.
- handrous 5y ago
  > doesn't quite make sense. You can't take that 25% and apply t against the in-patient and out-patient costs, because it's not at all clear that it fits into that bucket. Well, if it's not accounted for in that figure then where is it? There's another amount somewhere around $3k just not accounted for, then? I don't see anywhere anything like that much could be hiding in the rest of the data. I mean, these are from the link: > inpatient and outpatient care, which includes payments to hospitals, clinics, and physicians for services and fees such as primary care or specialist visits, surgical care, and facility and professional fees (see Methods for more details) and > Administrative costs include spending on running governmental health programs and overhead from insurers but exclude administrative expenditures from healthcare providers. So... where is it if not in the "inpatient and outpatient care" bucket? Sure, maybe minus whatever portion of that represents profit, OK, but that can't be so much as to render it anywhere near being negligible. Or is the 25% figure from the other link off by, oh, 5x or more?
  - bhupy 5y ago
    > So... where is it if not in the "inpatient and outpatient care" bucket? Sure, maybe minus whatever portion of that represents profit, OK, but that can't be so much as to render it anywhere near being negligible. > Or is the 25% figure from the other link off by, oh, 5x or more? No, the 25% figure from your link isn't off at all, it's that you're mixing up denominators. You can't take the 25% figure from hospital costs, the $10,637 from the per capita figure, and then conclude that hospital admin s 25% of $10,637. If you want to insert your number into my number in an apples-to-apples way, you have to actually look what hospitals pay per capita. There's a huge normalization step that you just skipped. Fortunately, your own link does this work: "Hospital administration costs ranged from 1.43 percent of gross domestic product (GDP) in the United States ($667 per capita) to 0.41 percent of GDP ($158 per capita) in Canada." $667 per capita is a drop in the bucket. If I were to guess, the reason why the analysis I linked didn't factor it in was because it doesn't change its conclusion: "The U.S. also spends more on administrative costs, but perhaps not as much as people think, and spends significantly less on long-term care." This is in line with my observation on the ground as well, especially the observation that admin costs typically involve extremely high upfront costs (setting up EHR systems, EDI integrations, book-keeping systems), but lower variable costs from an operating standpoint especially relative to the sheer cost of care itself (doctors, equipment, maintenance, etc etc etc).

bhupy 5y ago

> The admin costs in the US are roughly $937 + ($8,021 * 0.25) = $2942.25—and possibly worse, depending on how much of the stuff from other categories might fall under "hospital budget", though that may be evened out by the difference between budget and revenue (which is the biggest unknown factor here, trying to combine the info from the two links). This is incorrect, the inpatient and outpatient costs do not include the hospital admin fees. That figure only includes the fee-schedule payments per procedure. The fee-for-service model makes it rather easy to isolate that amount. That's why your statement here: > How is that not a very large part of the difference in costs? It looks like ~40% of the difference in total per capita spending, in fact. I'm sure that's a little off, but where am I going wrong that allows it to become negligible in your analysis? doesn't quite make sense. You can't take that 25% and apply t against the in-patient and out-patient costs, because it's not at all clear that it fits into that bucket.

handrous 5y ago
> doesn't quite make sense. You can't take that 25% and apply t against the in-patient and out-patient costs, because it's not at all clear that it fits into that bucket. Well, if it's not accounted for in that figure then where is it? There's another amount somewhere around $3k just not accounted for, then? I don't see anywhere anything like that much could be hiding in the rest of the data. I mean, these are from the link: > inpatient and outpatient care, which includes payments to hospitals, clinics, and physicians for services and fees such as primary care or specialist visits, surgical care, and facility and professional fees (see Methods for more details) and > Administrative costs include spending on running governmental health programs and overhead from insurers but exclude administrative expenditures from healthcare providers. So... where is it if not in the "inpatient and outpatient care" bucket? Sure, maybe minus whatever portion of that represents profit, OK, but that can't be so much as to render it anywhere near being negligible. Or is the 25% figure from the other link off by, oh, 5x or more?
- bhupy 5y ago
  > So... where is it if not in the "inpatient and outpatient care" bucket? Sure, maybe minus whatever portion of that represents profit, OK, but that can't be so much as to render it anywhere near being negligible. > Or is the 25% figure from the other link off by, oh, 5x or more? No, the 25% figure from your link isn't off at all, it's that you're mixing up denominators. You can't take the 25% figure from hospital costs, the $10,637 from the per capita figure, and then conclude that hospital admin s 25% of $10,637. If you want to insert your number into my number in an apples-to-apples way, you have to actually look what hospitals pay per capita. There's a huge normalization step that you just skipped. Fortunately, your own link does this work: "Hospital administration costs ranged from 1.43 percent of gross domestic product (GDP) in the United States ($667 per capita) to 0.41 percent of GDP ($158 per capita) in Canada." $667 per capita is a drop in the bucket. If I were to guess, the reason why the analysis I linked didn't factor it in was because it doesn't change its conclusion: "The U.S. also spends more on administrative costs, but perhaps not as much as people think, and spends significantly less on long-term care." This is in line with my observation on the ground as well, especially the observation that admin costs typically involve extremely high upfront costs (setting up EHR systems, EDI integrations, book-keeping systems), but lower variable costs from an operating standpoint especially relative to the sheer cost of care itself (doctors, equipment, maintenance, etc etc etc).