The other day, I was listening to a news story about how there are more people in healthcare working in billing and administration than there are doctors and nurses combined. And for the most part, largely brought on by managed care, the HMOs. So much for the premise that they were supposed to be saving money and reducing health care costs. Imagine that, there are more people working to figure out how much to charge you for your hospital stay than there are people taking care of you while you're in the hospital.
Actually, after having worked in US hospitals for the past few years, it's not all that hard to imagine. I noticed shortly after moving to the US that healthcare was definitely much more business oriented than it is in Canada. One of the first things I noted was that I saw a lot more administrative and non-patient care people than I did doctors, nurses or techs while I was walking along the corridors.
Healthcare billing is big business. There are companies that don't do anything except handle billing and coding for doctors' offices and hospitals. There are graduate programs in medical billing. The CPT code books are thicker than most unabridged dictionaries.
And the billing process is convoluted. I haven't seen the entire billing process from start to finish, but this is what I've encountered of it. After the doctor sees you, he might check off a few diagnosis codes on a form. Then there might be a dictated report, which is listened to and transcribed by a transcriptionist. From the form and transcripted report, a CPT coder (hopefully a properly trained and certified one) will select the appropriate codes to be billed for, which would then be sent to the billing group (internally or external). So between the doctor and your bill, there are several layers of people (at least 3) with minimal medical training deciding how much it's going to cost you.
UPDATE: And to top it off, who knows where your medical records end up. An article in SFGate (via slashdot) talks about how dictated reports from UCSF Medical Center ended up in a transcriptionist's hands in Pakistan, apparently through several levels of subcontracted transcription services. So hospitals contract out transcription services to a company, who in turn subcontracts out excess work, which gets subcontracted out to some other company, ad infinitum.
Oh, the insanity...