Are in the future of health care, if you follow the implications of a recent article in the New England Journal of Medicine. Analyzing the post 2006 healthcare reform situation in Massachusetts – an influential model for the national Accountable Care Act (ACA) passed in 2010– researchers found an increase of 18.4 percent in administrative staff from 2006-2009, compared to an 8 percent in the rest of the country. Meanwhile, jobs in non-administrative positions, including nurses and physicians, rose 9.3 percent, similar to the rest of the country (8.6 percent).

Researchers attribute this marked increase in administrative staff to the increased need to process applications, file insurance claims, submit data for regulatory compliance and perform other administrative duties.

The researchers note that while the demand for administrative support may be large nationwide once the ACA fully kicks in, it would conceivably lessen over time as administrative processes become more refined. Nevertheless, the analysis supports concerns about the administrative burden of health care reform. No matter how the ACA plays out, we’d bet good money on the future of health care as a dominant employment sector in the economy, with much of the growth coming in administrative, regulatory and “brokering” functions.

For an analogue in another sector of the economy, look at California’s state university system, where administrators outnumber teachers. It reminds one of a classic social history text, The Bureaucratization of the World. Prophetic.