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U.S. insurers and providers spent more than $800 billion in 2017 on administration, or nearly $2,500 per person — more than four times the per-capita administrative costs in Canada’s single-payer system, a new study finds.
Over one third of all healthcare costs in the U.S. were due to insurance company overhead and provider time spent on billing, versus about 17% spent on administration in Canada, researchers reported in Annals of Internal Medicine.
Cutting U.S. administrative costs to the $550 per capita (in 2017 U.S. dollars) level in Canada could save more than $600 billion, the researchers say.
“The average American is paying more than $2,000 a year for useless bureaucracy,” said lead author Dr. David Himmelstein, a distinguished professor of public health at the City University of New York at Hunter College in New York City and a lecturer at Harvard Medical School in Boston.
“That money could be spent for care if we had a ‘Medicare for all program’,” Himmelstein said.
To calculate the difference in administrative costs between the U.S. and Canadian systems, Himmelstein and colleagues examined Medicare filings made by hospitals and nursing homes.
For physicians, the researchers used information from surveys and census data on employment and wages to estimate costs. The Canadian data came from the Canadian Institute for Health Information and an insurance trade association.
United States vs. Canada
When the researchers broke down the 2017 per-capita health administration costs in both countries, they found that insurer overhead accounted for $844 in the U.S. versus $146 in Canada; hospital administration was $933 versus $196; nursing home, home care and hospice administration was $255 versus $123; and physicians’ insurance-related costs were $465 versus $87 They also found there had been a 3.2% increase in U.S. administrative costs since 1999, most of which was ascribed to the expansion of Medicare and Medicaid managed-care plans.
Overhead of private Medicare Advantage plans, which now cover about a third of Medicare enrollees, is six-fold higher than traditional Medicare (12.3% versus 2%), they report. That 2% is comparable to the overhead in the Canadian system.
Why are administrative costs so high in the U.S.?
It’s because the insurance companies and health care providers are engaged in a tug of war, each trying in its own way to game the system, Himmelstein said. How a patient’s treatment is coded can make a huge difference in the amount insurance companies pay. For example, Hammerstein said, if a patient comes in because of heart failure and the visit is coded as an acute exacerbation of the condition, the payment is significantly higher than if the visit is simply coded as heart failure.
More and more paperwork required
This upcoding of patient visits has led insurance companies to require more and more paperwork backing up each diagnosis, Himmelstein said. The result is more hours that healthcare providers need to put in to deal with billing.
“(One study) looked at how many characters were included in an average physician’s note in the U.S. and in other countries,” Himmelstein pointed out. “Notes from U.S. physicians were four times longer to meet the bureaucratic requirements of the payment system.”
The new study is “the first analysis of administrative costs in the U.S. and Canada in almost 20 years,” said Dr. Albert Wu, an internist and professor of health policy and management at the Johns Hopkins School of Public Health in Baltimore. “It’s an important paper.”
‘Inefficient and wasteful’ system
“It’s clear that health costs in the U.S. have soared,” Wu said. “We’re paying for an inefficient and wasteful fee-for-services system.”
“Some folks estimate that the U.S. would save $628 billion if administrative costs were as low as they are in Canada,” said Jamie Daw, an assistant professor of health policy and management at Columbia University’s Mailman School of Public Health in New York City.
“That’s a staggering amount,” Daw said in an email. “It’s more than enough to pay for all of Medicaid spending or nearly enough to cover all out-of-pocket and prescription drug spending by Americans.” (VOA)
The city of Delhi has seen it all; from sultanate rule, to dynasties, and to colonial rule. From monarchy to democracy, Delhi has gone through its phases. But, in order to know and explore the nuances of Delhi, you must read these beautiful books.
1. City of Djinns: A Year in Delhi by William Dalrymple
This book was written while Dalrymple was still flirting with his love for the Medieval India. The author writes, "Moreover the city- so I soon discovered- possessed a bottomless seam of stories: tales receding far beyond history, deep into the cavernous chambers of myth and legend," and just like this, Dalrymple takes you in a tour to discover Discover Delhi.
2. Delhi by Heart: Impressions of a Pakistani Traveller by Raza Rumi
This book explores how the author explores his identity as a South Asian Muslim and how his city of Lahore is a mirror image of Delhi. Rumi, in this book, tries to co-relate the past with the present by comparing its festivals, streets, and markets.
3. Delirious Delhi: Inside India's Incredible Capital by DavePrager
This book is quite interesting. The story of this book revolves around the lives of Dave and Jenny who have recently moved to Delhi when their firm began to go down. The city of Delhi in this book is shown through their eyes as they try to make their way in the city that holds together a very large population.
4. The Heart has its Reasons by Krishna Sobti, Translated by Reema Anand, Meenakshi Swami
The original title of this book is "Dil - o - Danish". This book tells the reader about the streets of Old Delhi and almost transport the reader back in the past. This book is basically set in the 1920's, and tells the tale of a man's extramarital affair, his children out of wedlock, black magic, and Chandni Chowk's rich culture of sweets and the perils of being a widow. Interestingly, many have compared the author of this book to Jane Austen.
5. Delhi: A Novel by Khushwant Singh
Who would talk about Delhi and not remember Khushwant Singh? This amazing book is just like a narrative of the author's fulfilled love affair with the city and with a eunuch. The narrator in this book is an aging man who is trying to discover the city. This book is truly a masterpiece, where it takes the readers on the history of Delhi glimpsing at what makes the city what it is– simply beautiful.
There are some of the Indian cities which are older than time. Therefore, we must know which cities are they, and what has been their history!
1. Varanasi (1200 BC–)
Varanasi is one of the oldest cities of India, and has been a center of religious and cultural activity since the Bronze Age. In fact, this city might have been in existence from a very long time, since it finds mention in the Rig Veda. It is believed that the city of Varanasi was thriving for more than 1600 years before the fall of the Roman Empire in Europe. This city is one of the holiest places for Hindus and Jains, and even Lord Buddha gave his very first sermon here in 528 BC. In Hinduism, it is believed that dying in Varanasi brings salvation, which is the reason why the city is always brimming with pilgrims.
2. Ujjain (700/600 BC–)
Ujjain was once considered as one of the most prominent cities in the Middle India. In fact, the name of this city is repeatedly mentioned in the literature of that period, i.e. in the works of stalwarts like Kālidāsa. This city has seen the rise and fall of numerous empires, from the Mauryas to the Avantis, Nandas, and even the Guptas. This city, just like Varanasi, is also considered as one of the holiest cities in India, and hosts one of the officially recognized Kumbh melas, the Ujjain Simhastha Kumbh, in which people across the world take place.
3. Madurai (500 BC–)
Madurai been a major center of culture and trade for more than 2500 years. In fact, the name of this city has been mentioned in the writings of the great traveler, Megasthenes, and has been ruled by several empires from the Pandyas and the Cholas to the Karnata, and finally the British. Interestingly, ‘'Koodal,' was one of its ancient name which means 'a congregation of learned men'. There is no doubt that Madurai was an epicenter of scholars and religious teachers in the southern part of India.
4. Thanjavur (300 BC–)
Thanjavur was formerly known as Tanjore. This city is pretty famous for its Tanjore style of painting, which is a traditional style that is characterised by the use of gold foil, religious imagery, and simple compositions. This city is best known for being the home of the Great Living Chola Temples, which is now a UNESCO World Heritage site. Till date, people across the world visit this place in order to experience its rich history and heritage.
By- Digital Hub
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Require a Wig
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Also read: Gemstones: Fashion Statements
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Human hair wigs on display at a store Image source: Photo by Markus Spiske on Unsplash
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