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    As a former Dean and appointed University Professor and Endowed Department Chair, Dr. David Edward Marcinko MBA was a NYSE broker and investment banker for a decade who was respected for his unique perspectives, balanced contrarian thinking and measured judgment to influence key decision makers in strategic education, health economics, finance, investing and public policy management.

    Dr. Marcinko is originally from Loyola University MD, Temple University in Philadelphia and the Milton S. Hershey Medical Center in PA; as well as Oglethorpe University and Emory University in Georgia, the Atlanta Hospital & Medical Center; Kellogg-Keller Graduate School of Business and Management in Chicago, and the Aachen City University Hospital, Koln-Germany. He became one of the most innovative global thought leaders in medical business entrepreneurship today by leveraging and adding value with strategies to grow revenues and EBITDA while reducing non-essential expenditures and improving dated operational in-efficiencies.

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    As a state licensed life, P&C and health insurance agent; and dual SEC registered investment advisor and representative, Marcinko was Founding Dean of the fiduciary and niche focused CERTIFIED MEDICAL PLANNER® chartered professional designation education program; as well as Chief Editor of the three print format HEALTH DICTIONARY SERIES® and online Wiki Project.

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Traditional Methods of Healthcare Finance

A Brief Historical Review of Delivery

Dr. David Edward Marcinko; MBA CMP™


Dr. Marcinko

Prior to 1970s, the healthcare reimbursement system was not a monolithic complex and most Americans received their healthcare through one of five third-party organizations:  (1) Blue Cross/Blue Shield (pre-paids), (2) Commercial insurance (private) companies, (3) Medicare (federal-elderly), (4) Medicaid (state-poor) and (5) CHAMPUS (military).  

Four Fragmented Participants 

The four participants in this fragmented system were; the patient (consumer), the physician (provider), the employer (buyer or payer) and one of these third-party intermediaries (TPIs).  

Moreover, the doctor-patient relationship was often muddled by the third parties who became brokers between MD and patient; both who merely sought to understand: (a) who was responsible for payment; (b) how the MD would assist the patient obtain reimbursement, and, (c) how to establish the ultimately responsible party? 

Commercial Insurance and the CPI 

In the meantime, commercial insurance medical costs were accelerating at a rate greater than three times the Consumer Price Index [CPI], a measure of goods and services in a market basket intended to be representative of a typical patient’s purchases.  

There was no single reason for medical cost escalation, but many economists believed the following circumstances conjoined at one point in time to increase health care costs dramatically. Important factors include the following: 

1. Law of Supply and Demand (increasingly too many doctors chasing too few patients). 

For example, Milliman & Robertson, the actuarial firm, estimated that only about 70% of physicians actively practicing medicine in the United States are necessary; a decade ago. The same situation is true for other healthcare employees. Mergers, acquisitions, outsourcing, closings and consolidations have only exacerbated the situation. 

2. The US Federal Budget Deficit is about 3.5 trillion dollars, since income is 1.5 Trillion Dollars and outflow is 5 Trillion Dollars.

On the other hand, the budget surplus that existed several years ago was dissipated by 2005, thanks to the flagging economy and War with Iraq.  

Additionally, the federal budget further demonstrates the severity of the healthcare cost problem as a percentage of the national budget:  

  • Social Security = 21%
  • National Debt Interest = 20%
  • Medicare and /Medicaid = 16%
  • Defense Spending = 15%
  • Domestic Spending = 15%
  • Miscellaneous Spending = 11%
  • International Spending = 2% 3. 

Increased administrative costs and advancements in health information technology. The primary use of new technology has been in the areas of diagnosis and treatment.  

However, HMOs also use technology to increase operational efficiency and reduce costs. The price paid is in the loss of jobs or reduction in the skill level needed to perform certain tasks, formerly done by trained technicians, nurses or physicians. 

4. Malpractice phobia, misinformed patients, hungry trial lawyers and class action lawsuits. 

The median malpractice award for all medical negligence claims increased by 14% since 2000, and in childbirth cases was $1.3 million, more than double the median for any other type of medical malpractice verdict.


According to some industry pundits, even seemingly small healthcare premium amounts matter.  

For example, the difference between a high and lost cost health care plan is about $20-25 per member/per month. Nevertheless, low cost provider groups gained enrollment, as high cost providers lost enrollment at this level; in one study.


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