If by shareholder value you include insurance companies etc not just the institutions themselves, it’s well over half.
Doctor time talking to an insurance company either directly or through paperwork is not actually providing any care during that time. Where things go vicious is because doctors are now so inefficient the time they are actually useful becomes increasingly valuable driving ever more paperwork to justify that time.
Physicians spend very little time directly dealing with insurance companies. They (or their employers) hire back office administrative staff for that. This is somewhat wasteful and inefficient but it doesn't directly impact the time that clinicians have available for patient care. Usually the physicians only have to get directly involved in rare peer-to-peer consults with health plans for complex cases that fall outside of normal clinical practice guidelines.
It’s the indirect time that’s most at issue here, a friend of mine is happy to take a significant pay cut and work at the VA to avoid the hassle. It’s a government institution and he still feels way more productive and less stressed.
In private practice a physician now needs to handle extra employee(s), there’s often a range of software system issues etc. Even in a hospital setting where other people are handling most of this stuff that’s a long way from zero friction.
The insidious issue is even a 1% drop on doctor efficiency gets magnified by everyone taking a cut of the transaction.
Doctor time talking to an insurance company either directly or through paperwork is not actually providing any care during that time. Where things go vicious is because doctors are now so inefficient the time they are actually useful becomes increasingly valuable driving ever more paperwork to justify that time.