Abstract
This review article canvassed international comparisons of administrative costs in health care as presented by a book from the Office of Technology Assessment. It argued that the real issue is not whether Americans spend too much on administration but whether their spending buys what Americans want, including not only medical care but also a decentralized, private system of control. It is appealing to argue that Canada has a better and fairer system because it offers similar health outcomes, better overall protection against risk, and higher consumer satisfaction ?all for less money per head?but not because Canada has fewer managers and clerks. Getting the patient the best value is the key, not achieving some right level of administrative cost. (Journal of Law, Medicine and Ethics 1995 Summer; 23(2): 186-194).
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