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HEALTH CARE SYSTEMS 5 The visibility of administrative professionals in the health industry increased in recent times due to the common financial issues faced by many governments to sustain the burden of health care systems. However, albeit somewhat less „popular‰ than direct caregivers such as medical doc- tors and nurses, the history of medical administrators goes back by at least two hundred years. In the United States, the development of health care management as a career field began at the end of the 19th century, when huge discoveries in medical technologies such as the antibiotics and anes- thetics led to the proliferation of hospitals. Between 1875 and 1925, the number of hospitals in the United States grew more than fortyfold from just over 170 to about 7,000. Early hospital administrators had no formal administration training, though. Most of these so-called superintendents were nothing but nurses, medical doctors, laymen, and members of the clergy with simple admin- istrative duties. At the end of 1899, the Association of Hospital Super- intendents was founded in Cleveland to establish guidelines for medical practices. Later in 1906, the name of this association was officially changed to the American Hospital Association. In 1900, the first formal hospital administration and nursing school administration educational programs were established for nurses at Colum- bia Teachers College in New York. In 1934, the University of Chicago was the first university to offer a two-year graduate degree curriculum in hospi- tal administration. Today, the Commission on Accreditation of Healthcare Management Education (formerly the Accrediting Commission on Gradu- ate Education for Hospital Administration) is the accrediting agency for graduate programs in health administration. Administrative activities eat a significant part of the hospital budgets, with an average of approximately 12% in most world countries. How- ever, this percentage may rise even up to twofold in some highly devel- oped nations, such as England (15.5%), the Netherlands (19.8%), and the United States (25.3%). As of 2013, Duke University Hospital in Durham, North Carolina, had more billing clerks (1,300) than hospital beds (900). In America, where the complex insurance system requires considerable administrative efforts to be properly managed, the percentage of health spending is much higher than in other countries such as the United King- dom: 8% versus 2.5%. In particular, up to 1.43% of the entire American economy is spent on hospitalsÊ administrative costs with an estimated yearly expenditure of roughly $218 billion (twice the countryÊs entire food budget). It is interesting to note, however, now evidence shows that public financing is substantially more efficient than private financing. Medicare administrative costs account for less than 2% of all costs, compared to 14ă15% for private health plans.