In this 1993 NEJM study, Steffie Woolhandler and David Himmelstein perform the first comprehensive analysis of administrative costs in U.S. hospitals. They find that administrative costs account for an average of 24.8 percent of hospital spending, more than double that of Canadian hospitals (~10 percent). Enrollment in HMOs and competitive bidding for managed-care contracts did not lower administrative costs. Read “Administrative Costs in U.S. Hosptials” (pdf)