title: Taking care of business: HMOs that spend more on administration deliver lower-quality care.
abstract: The authors analyzed health maintenance organizations' administrative costs and quality measures from the National Committee for Quality Assurance's Quality Compass database for the years 1997-2000. HMOs with higher administrative overhead had consistently worse quality scores in univariate analysis. Multivariate analyses controlling for geographic region (all years) and HMO model type (1997 and 1998 analyses only) confirmed that higher administrative costs were associated with lower quality. Excess HMO bureaucracy is not only wasteful but harmful.
authors.affiliation: Department of Medicine, The Cambridge Hospital, MA 02139, USA. dhimmelstein@challiance.org
authors.forename: David U
authors.initials: DU
authors.lastname: Himmelstein
authors.forename: Steffie
authors.initials: S
authors.lastname: Woolhandler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D005260:Female; D006279:Health Maintenance Organizations / Q000191:economics / Q000458:organization & administration / Q000592:standards*; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D015999:Multivariate Analysis; D011787:Quality of Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D014481:United States