Michael Anne Kyle and Austin Frakt released a pretty awesome paper last week in Health Services Research. They ask — for five basic types of administrative functions related to medical care, do people not get the care that they think they need because of burden of completing a task?
We assess the prevalence of five common patient administrative tasks—scheduling, obtaining information, prior authorizations, resolving billing issues, and resolving premium problems—and associated administrative burden, defined as delayed and/or foregone care….
Seventy-three percent of respondents reported performing at least one administrative task in the past year. About one in three task-doers, or 24.4% of respondents overall, reported delayed or foregone care due to an administrative task: Adjusted for demographics, disability status had the strongest association with administrative tasks (adjusted odds ratio [OR] 2.91, p < 0.001) and burden (adjusted OR 1.66, p < 0.001). Being a woman was associated with doing administrative tasks (adjusted OR 2.19, p < 0.001). Being a college graduate was associated with performing an administrative task (adjusted OR 2.79, p < 0.001), while higher income was associated with fewer subsequent burdens (adjusted OR 0.55, p < 0.01).
This is a unique study in that it looks at the process of arranging care and working with payment systems to get care paid for instead of the more common administrative burden literature that looks at program enrollment. These individuals are already enrolled into some payment mechanism (employer insurance or Medicare or Medicaid etc) but they still face significant burdens in using their payment mechanisms to get their needed care. I know that I will be citing this paper a lot over the next few years to justify my ever deeper and more esoteric dives into the ACA and Medicaid.
There are a few common threads. Burden is not random nor uniform. Instead, it is concentrated heavily on people who have enough other challenges going on in their lives. College graduates and people with money are able to use their pre-exisiting skills and inclinations to navigate complex bureaucrat entities with relative easy. They are also likely (I am speculating) able to choose providers and/or payment systems that are lower burden in general. Burden is a little invisible tax on time and cognitive capacity for healthy upper middle class folks but a significant drain on resources and attention for individuals who routinely interact with the medical system and who can’t just throw money at a problem.