How Administrative Burdens Can Harm Health

The COVID-19 pandemic has magnified existing policy challenges and created significant economic disruption leading to high numbers of unemployment, financial insecurity, and limited health care access for many Americans. As a result, more people need support from social welfare services like unemployment insurance, food stamps, Medicaid, and more.

In a recent Health Affairs policy brief, McCourt professors Pamela Herd and Don Moynihan outline how bureaucracy, or administrative burdens, can create barriers to critical social welfare programs and how the structure of the programs may not be designed to best support people in need.

“The COVID-19 pandemic made starkly visible not just the holes in the safety net that result from policy design but also those that result from policy administration,” Herd says.

“In some instances, the cumulative stress and psychological costs of navigating administrative burdens to receive some of the health-promoting services may actually harm health,” explains Moynihan.

Below are a few key points from Herd and Moynihan’s health policy brief on administrative burdens and how they can negatively impact health, especially during a pandemic. Read the full brief.

Key Points

• Administrative burdens can negatively affect health by blocking people from accessing health-promoting social welfare programs such as food stamps and income supports, and may also have more direct health impacts via the psychological and stress mechanisms that come from navigating burdensome bureaucracies.
• Administrative burdens include learning costs, such as finding out whether one is eligible for a program; compliance costs, such as burdensome paperwork and T documentation; and psychological costs, such as the stress and stigma that people feel when interacting with government programs.
• We know relatively little about the downstream health implications of negative encounters with bureaucracies. Documenting the health effects of burdens is a compelling research opportunity that population health researchers are uniquely situated to address. To fulfill that opportunity, researchers need to pay just as much attention to the administration of social and economic policies as they do to their design.
• Administrative burdens associated with social welfare policies and programs may be just as important determinants of health as the policies themselves. Public officials should look to minimize burdens.

Source: Health Policy Brief: How Administrative Burdens Can Harm Health,” Health Affairs, October, 2020.