Admin overhead

Read it this way The private-insurance overhead band is both the larger of the two layers and the faster-growing one, expanding from $63.1B in 2000 to $294.1B in 2022 while government program administration grew more slowly. Total administration reached $347.6B by the last year shown. Use this chart to identify where administrative cost sits in the system and why the recommendation targets both payer rules and provider operations.

CMS Office of the Actuary, National Health Expenditure Accounts (Table 2) · 2022 · source

Read it this way Administration's share of national health spending has moved in a narrow band, mostly 7 to 8 percent, rather than trending steadily, peaking at 8.45 percent in 2020 and sitting at 7.58 percent in 2022. Normalizing to a share strips out inflation, which the dollar totals in the chart beside it do not. Use this chart to identify where administrative cost sits in the system and why the recommendation targets both payer rules and provider operations.

CMS Office of the Actuary, National Health Expenditure Accounts (Table 2) · 2022 · source

Read it this way Small-group plans spend proportionally more of every premium dollar on overhead than either individual or large-group plans. Smaller risk pools generally have less ability to spread fixed administrative costs, which is the likely driver of this ordering. Use this chart to identify where administrative cost sits in the system and why the recommendation targets both payer rules and provider operations.

CMS, Medical Loss Ratio Public Use File · 2022 · source

Read it this way All three market lines stay above their applicable floor in every year shown, so no market is violating the legal minimum. The 2020 dip and 2021 rebound visible across all three, most pronounced in the individual market, lines up with pandemic-year care patterns rather than a change in insurer behavior. Use this chart to identify where administrative cost sits in the system and why the recommendation targets both payer rules and provider operations.

Caveat CMS-computed values run through 2022. Later years rely on a secondary KFF basis (simple loss ratios, with small and large group merged in 2024) and are not blended in here.

CMS, Medical Loss Ratio Public Use File · 2022 · source

Read it this way Rebates swing sharply from year to year rather than rising steadily, peaking at $2.46B in 2019 and falling by more than half to $1.03B in 2021 before partially recovering to $1.64B in 2024. That volatility is why the KPI beside this chart calls the cumulative rebate a small, inconsistent constraint rather than a steady one. Use this chart to identify where administrative cost sits in the system and why the recommendation targets both payer rules and provider operations.

KFF, Medical Loss Ratio Rebates · 2024 · source

Read it this way The United States bar is nearly double the peer-median reference line, and every peer nation shown sits below that line. This is 2011 hospital-level data only, a different measure from the national-spending share charted in the payer tab, so the two figures should not be added together. Use this chart to identify where administrative cost sits in the system and why the recommendation targets both payer rules and provider operations.

Caveat Hospital-level administrative cost share only, 2011 data. This is a different measure from the national-spending line in the payer tab and the two are not substitutable.

Himmelstein et al., Health Affairs, hospital administrative costs in eight nations · 2011 · source

Read it this way Urban hospitals report a higher total administrative share than rural hospitals, but the salary subset is smaller for urban hospitals, meaning most urban overhead growth is in non-salary costs. Rural hospitals' overhead is comparatively more salary-driven even though its total share is lower. Use this chart to identify where administrative cost sits in the system and why the recommendation targets both payer rules and provider operations.

Health Affairs Scholar, HCRIS administrative and general costs 2011-2022 · 2022 · source

Read it this way Administration and operations spending is almost exactly double direct patient care spending on this broadest definition. The caveat flags that hospital admin-burden estimates span from 21 percent on the narrower HCRIS measure to roughly 2-to-1 here, so the range itself, not either single figure, is the finding. Use this chart to identify where administrative cost sits in the system and why the recommendation targets both payer rules and provider operations.

Caveat Trilliant Health broad definition, 2023, not the narrower HCRIS scope of the grouped bar. Hospital admin-burden estimates span 21 percent (narrow) to about 2:1 (broadest), and the range is the point.

Trilliant Health, hospital administrative expenditures · 2023 · source