Patient administrative burden: a scoping review

High administrative costs are a notable feature and frustration of the American health care system. Administrative complexity drives excess health care spending and clinician burnout. There is growing interest in patient administrative burden: the nonclinical, administrative work a patient must do to use the health care system.

Following the PRISMA-ScR framework, we conducted a scoping review to synthesize empirical evidence characterizing patient administrative burden in US health care delivery from 2002-2024 using a systematic search across 4 indexed databases. To conduct this search in the absence of standard MeSH (Medical Subject Heading) terms, we first developed a conceptual model of "patient administrative burden" to define inclusion and exclusion criteria.

Sixty-three studies were identified across the patient journey: seeking care, receiving care, and following up to resolve care issues. Insurance selection, as part of care seeking, had the most mature evidence base, whereas patients' roles in identifying and solving health system problems are especially understudied.

Measurement of health care administrative costs focus on clinicians and health care organizations and likely understate total costs given the in-kind work performed by patients. Improving systematic data collection and incorporating measures of patient-facing administrative work would provide a more complete accounting of administration costs.