Newspaper article St Louis Post-Dispatch (MO)

Paper Pushers Proliferate More Administrators Than Doctors in U.S. Health System

Newspaper article St Louis Post-Dispatch (MO)

Paper Pushers Proliferate More Administrators Than Doctors in U.S. Health System

Article excerpt

Who is minding your health care?

It is probably a doctor, maybe some nurses, and a small phalanx of case managers, utilization review watchdogs, accountants, hospital executives and managed-care moguls.

Health care has many more people pushing papers than practicing medicine, a new study finds.

Two Harvard University doctors analyzed 25 years of national health employment data and found that the share of U.S. medical workers who provide health care - doctors and nurses, for instance - has declined. Meanwhile, the ranks of people "managing" health care via paperwork, computer analysis and calculator has skyrocketed.

The study, titled "Who Administers? Who Cares?" was published last month in the American Journal of Public Health.

The authors compare the U.S. medical work force with Canada's nationalized health care system. Canada employs more nurses per person than the United States does, even though Canada spends less on health care per person.

"Managed care squeezes doctors, nurses and patients but eats up most of the savings with bureaucracy," the study states. Administrative jobs accounted for 57 percent of all health sector jobs created in 1993 (the last year studied) and practically all the growth in hospital employment.

The study's authors admit that they are no friends of managed care. Drs. Steffie Woolhandler and David Himmelstein are founders of Physicians for a National Health Program, an organization advocating nationalized health insurance. Himmelstein gained nationwide publicity recently when a major insurer fired him for complaining about gag rules.

The new study, published last month, points out that between 1968 and 1993 the number of health care administrators grew nearly sevenfold, while the number of doctors rose just 77 percent and the number of registered nurses grew 160 percent. Doctors' offices alone hired 550,000 full-time administrators - almost one per doctor.

Although the study points to managed-care insurers as one of the main causes of bureaucratic bloat, the study doesn't really count the 250,000-plus people employed by these companies. Nor does it count the people in employers' insurance-benefits departments. …

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