America's Health Care System is Broken: What Went Wrong and How We Can Fix It. Part 3: Hospitals and Doctors

Am J Med. 2019 Aug;132(8):907-911. doi: 10.1016/j.amjmed.2019.03.010. Epub 2019 Mar 28.


Thirty-two percent of US health care spending goes to hospital care, and 20% goes to physicians' charges. The cost of hospital care in the United States is 2-3 times greater than in most similar countries. A large part of the high cost is due to a very large administrative overhead. Both higher quality and lower cost would be achieved if complex procedures were done in fewer centers. Hospitals with a geographic or prestige monopoly receive higher payments than warranted. As physicians are increasingly employed by hospitals rather than independent, costs go up with no added benefit to patients. The United States has too many specialists and too few primary care physicians. Practice guidelines are slanted to favor expensive treatments, often with little solid evidence behind the recommendations.

Keywords: Health care costs; Health care system; Hospital costs; Hospitals; Physician practice.

Publication types

  • Review

MeSH terms

  • Delivery of Health Care / methods
  • Delivery of Health Care / standards*
  • Delivery of Health Care / trends
  • Efficiency, Organizational / statistics & numerical data
  • Health Expenditures / statistics & numerical data
  • Health Expenditures / trends
  • Hospitals / statistics & numerical data
  • Hospitals / trends*
  • Humans
  • Partnership Practice / economics
  • Partnership Practice / statistics & numerical data
  • Physicians / economics*
  • Physicians / statistics & numerical data
  • United States