Use of administrative personnel in hospitals: A three nation comparison

Differences in the costs of health care systems among industrialized countr ies has been the focus of several studies. Labor costs, specifically the am ount of resources used for administration, are considered to contribute to differences in overall health care costs. To determine differences in the u se of labor resources, especially administrative and managerial, among Amer ican, Austrian and German hospitals, we use a convenience sample of one Aus trian, one German and two United States (US) tertiary care centers. In our analysis we used payroll data of the four hospitals. First, we categ orized job titles and created job categories. Subsequently, we calculated f ull time equivalents (FTEs) per job category and compared them across count ries. Adjustments were made for differences in health systems. The main out come measures were FTEs per patient day and per discharge in each job categ ory. In the US hospitals > 19% of FTEs were in administrative categories as comp ared with < 8% in the European hospitals. For administrative managers, US h ospitals used > 11 times the labor per patient day of the European institut ions. Among administrative areas, the largest absolute FTE difference was i n financial operations. US hospitals used > 5 FTEs of personnel per 10,000 patient days versus < 1.0 FTE in the European hospitals. Given the kinds of administrative work done in US hospitals compared to Aus tria and Germany, differences in the organization and financing of these co untries' health care systems may account for an important part of the highe r number of US personnel.