Date of Award
Spring 3-14-2025
Embargo Period
7-1-2025
Document Type
Dissertation
Degree Name
Doctor of Health Administration
Department
Health Administration
College
College of Health Professions
First Advisor
Dunc Williams, Jr.
Second Advisor
Kit Simpson
Third Advisor
Larry Leaming
Abstract
Administrative and general (A&G) expenses in U.S. hospitals represent a growing financial burden, accounting for 15%–30% of healthcare expenditures. Despite this impact, A&G trends remain underexamined, particularly between rural and urban hospitals. This study used Medicare Cost Report data from over 4,400 short-term acute care hospitals from 2011 to 2022, combined with qualitative interviews with hospital executives, to assess rural-urban differences in A&G expenses. Using an explanatory sequential mixed-methods design, rural hospitals were found to consistently spend a higher proportion of total expenses on A&G salaries—18% more than urban hospitals, even after adjusting for hospital and financial characteristics. Although salary-related expenses declined, non-salary A&G costs increased across all hospitals. Interviews revealed that regulatory burdens, payer fragmentation, and staffing inefficiencies were primary cost drivers. Rural hospitals were especially affected due to limited scale and staffing capacity. Policy reforms that simplify compliance requirements and standardize payer processes could help reduce administrative burdens and improve financial sustainability, especially for rural institutions.
Recommended Citation
Handlon, Lauree, "Quantifying Trends in Hospital Administrative Costs: Examining Urban-Rural Disparities, Barriers, and Opportunities for Cost Reduction in Healthcare" (2025). MUSC Theses and Dissertations. 1034.
https://medica-musc.researchcommons.org/theses/1034
Rights
Copyright is held by the author. All rights reserved.