How Admnistrative Burdens Can Harm Health

A new health policy brief from Health Affairs with support from the Robert Wood Johnson Foundation examines the administrative burdens that can block access to some safety-net programs and, as a consequence, undermine a person’s health. This brief joins Health Affairs’ ongoing series of policy briefs on social determinants of health.

The COVID-19 pandemic and the related economic downturn have further exposed the gaps in the United States’ social welfare system, including the often-byzantine bureaucracies that applicants for benefit programs must navigate. In just one example highlighted by the brief, even before the pandemic, only three out of four of those eligible for unemployment benefits actually received them, with significant documented race disparities already established. Since the start of the pandemic, news stories have reported frequent cases of crashing websites, confusing forms, and other barriers to those applying for unemployment benefits. Similar barriers have traditionally been faced by those applying for other critical health-supporting social welfare programs such as the Earned Income Tax Credit, the Supplemental Nutrition Assistance Program, and Medicaid.

The brief documents the role of social welfare programs in protecting health, defines and conceptualizes administrative burdens, and details how these burdens limit access to health-protective social welfare supports. The barriers caused by administrative burdens include the effort needed to learn about programs and complete the necessary documentation to obtain and keep benefits and the degree of anxiety, loss of autonomy, or sense of stigma that can arise from interacting with programs. The discussion is encapsulated by the exhibit presented here.

In addition to addressing how administrative burdens may undermine health by reducing access to different programs, the brief calls for research exploring the direct effects of administrative burdens on health, such as through increased stress. The authors conclude that health-promoting policies may actually harm health if the cumulative stress and psychological costs of navigating their administrative burdens causes harm, and that the administrative state may be just as an important determinant of health as are the policies themselves.

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