Administrative Burdens in Healthcare: Evidence for Multiple Disciplines

Session Submission Type: Panel

Abstract

This panel session includes papers studying different administrative burdens in healthcare from a variety of disciplines. Administrative burdens refer to learning costs, compliance costs, and psychological costs imposed through bureaucratic encounters with the government (Herd and Moynihan, 2018). Administrative burdens matter because they impact the public’s perception of government, impact whether people get benefits they are legally entitled to, and can play a role in creating inequality (Herd and Moynihan, 2018).

One studies the new work requirements for Medicaid that will go into effect in January 2027 by studying the role of the medical frailty exemption. The authors use algorithms to estimate the size of the exempt population and studies state-by-state variation in who can be identified as exempt using claims data. They will also study the role of the lookback period in determining how many people are eligible for the exemption. Understanding how exemptions for work requirements will impact people is vital for preserving coverage for vulnerable population.

Another paper studies how the complexity of signing up for Medicare leads people to pick insurance policies that meaningfully differ from the person’s stated priority in picking a plan. Results from a nationwide survey indicate that just over half of people pick a plan that is best aligned with their needs. These can impact many other important outcomes such as spending, provider access, risk of prior authorization and whether there is forgone care. Reducing administrative burdens in Medicare is also important for the long-term legitimacy of the program.

Another paper quantifies how increasing reauthorization frequency impacts treatment continuation for Medicaid patients. Prior authorizations expire and additional paperwork is required for continued use. The authors find that shortening the renewal interval is associated with substantial reductions in sustained use of continuous glucose monitoring systems (CGMs) among beneficiaries with a Type 1 Diabetes diagnosis. Since research finds CGMs improve patient health and are cost-effective, this could have significant impacts on both patient health and Medicaid’s finances.

The other paper examines changes in children’s Medicaid coverage during the unwinding period following the end of the federal continuous enrollment requirement enacted during the COVID-19 pandemic. It identifies children of immigrants as one of the groups experiencing the largest declines in coverage. It also investigates whether variation in state Medicaid policies is associated with declines in children’s coverage and disparities across groups during this period, including whether policies affecting adults are associated with coverage changes among children.


Taken together, these papers provide timely and relevant information for policy makers interested in understanding the consequences of administrative burdens in healthcare. Using a variety of methods and settings, these papers document that administrative burdens matter for how people interact with government healthcare.

Policy Area

• Health Policy

Chair

• Michal Horný, University of Massachusetts at Amherst

Discussant

• David Anderson, University of South Carolina

Organizer

• Amanda P Gaulke, Kansas State University

Individual Presentations

• Administrative Burden and Treatment Continuation: Evidence from Continuous Glucose Monitoring in Medicaid - Presenting Author: Amanda P Gaulke, Kansas State University; Non-Presenting Co-Author: Daniel Grossman, West Virginia University; Non-Presenting Co-Author: Caroline Welter, West Virginia University

• When Choice Becomes Burden: Medicare Enrollment Complexity and Patient Administrative Burden - Presenting Author: Miranda Elyse Yaver, University of Pittsburgh

• Identifying the Population Exempt from Medicaid Work Requirements via Medical Frailty - Presenting Author: Ari Ne'eman, Harvard University

• Administrative Barriers and the Medicaid Unwinding: Parental Nativity and Medicaid Coverage Among Citizen Children - Presenting Author: Yiyu Chen, Independent; Non-Presenting Co-Author: Christopher Wodicka, University of Pennsylvania