Postponed or skipped blood work
Postponed or skipped filling prescriptions
Skipped doses of prescribed drugs
The 510 responses included in this study were selected to provide equal representation from major U.S. geographical regions (Northeast, Southeast, West, and Midwest). Half of the participant population was selected from patients or survivors who had breast, colorectal, lung, or prostate cancer; the other half was comprised of patients and survivors who had any other type of cancer.
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Results: Participants engaged in an average of one administrative task and one delay or nonadherence behavior at a frequency of “sometimes” or higher. After adjusting for age, race/ethnicity, education, and monthly out-of-pocket costs, participants who engaged in any administrative tasks were 18% more likely to experience any treatment delays or nonadherence than participants who did not engage in administrative tasks. Engagement in each additional task was independently associated with an increase in treatment delays or nonadherence.
The survey showed that 55% of participants “never” or “rarely” engaged in any administrative tasks. Doherty and colleagues performed another analysis to better examine the effects of increasing administrative burden on the frequency of treatment delays or nonadherence. After adjusting for age and estimated monthly out-of-pocket care costs, each unit increase of administrative burden (additional tasks or increasing frequency) was associated with a 32% higher frequency of treatment delays or nonadherence.
While age, race/ethnicity, and monthly out-of-pocket costs were more strongly associated with treatment delays or nonadherence than administrative burden, Doherty and colleagues noted that African Americans were more likely to engage in administrative tasks and experience treatment delays or nonadherence than other racial and ethnic groups.
Author’s Comments: These data suggest that administrative burden may exacerbate existing health disparities among marginalized groups, Doherty said.
“For those who do engage, there’s frustration, exhaustion, and I think a sense of alienation. If you send me a bill erroneously and can’t help me correct it, you’re showing me you don’t care about me.”
Doherty hopes this work may help spur further studies and conversations about how to begin simplifying the system. “I think we’re at a place now where we may want to quantify how much improvement in outcomes we might see if we alleviated some of these administrative burdens,” she said.
