The Eye Popping Tale of Two Health Care Claims Systems

When economists talk about the burden of administrative overhead in the current US health care system and the potential savings to be recovered from simplifying the system, what are they talking about exactly? These two flow charts make it abundantly clear that the tortuous claims system is a very large part of the cost problem in the US, and that a single-payer system is the cure.

Henry Broeska, an expert on Health Care Administration, concludes that "Health economists analyzing a single payer system don't account for enough of the savings derived from the elimination of our chaotic claims processing methods."

Advocacy Tip: Take a screen shot of each system on your phone to share with people.

US Claims Processing System (click to enlarge):

By the way, the author says "In fact, the illustration doesn't include nearly enough features; there are layers upon layers of processes and rules that sit below what is shown on top."

Canadian Single-Payer Claims System:


For the details, read Broeska's "Healthcare Claims Processing" post soon to be published in his upcoming book The Healthcare for All Handbook. Broeska has worked in several areas of medical research and healthcare administration in the US and Canada and has a Ph.D in Health Care Administration from Brightlands University. As Broeska concludes, "It’s time to take a serious look at how other countries deliver healthcare for half of what we pay before the harm the current system inflicts upon the country becomes an unrecoverable condition."

Thanks to Henry Broeska and One Payer States for sharing this information.


More claims processing truth bombs:

"By one estimate, for every 10 physicians providing care, almost seven additional people are engaged in billing-related activities." -- 2018 NY Times article.

"Duke University Hospital has 900 hospital beds and 1,300 billing clerks. The typical Canadian hospital has a handful of billing clerks." -- David Cutler, Harvard University Health Economist, PBS interview, Why Does Health Care Cost So Much In America? 

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