• Posted September 15, 2021

Medical Paperwork: So Bad Some Folks Skip Care

Getting prior authorizations to see a specialist, dealing with errors on medical bills and even scheduling appointments can be a big hassle.

That's clear to anyone who has spent time on the phone handling issues with insurance companies or doctors' offices.

For some patients, in fact, it's a hurdle that's caused them to delay or even forgo needed medical care.

"It is the thing people in my personal life complain to me about the most," said Michael Anne Kyle, co-author of a new study on the topic.

To research the issue, Kyle modeled questions after past surveys that have asked patients about the impact of financial barriers and access to care. But instead of finances, the survey asked about the impact of various administrative tasks.

"We had no idea what we would find and it was really interesting to learn that they are a consequential barrier to access," said Kyle, a postdoctoral fellow in the department of health care policy at Harvard Medical School, in Boston.

Besides scheduling appointments, administrative tasks can include obtaining information from an insurer or a provider, resolving problems with insurance premiums, dealing with billing issues and getting pre-authorizations for care.

While about three-quarters of the 4,155 nonelderly people who responded to the survey said they had done at least one health care-related administrative task in the past year, one-quarter said they had delayed or skipped care because of these tasks. That's similar to the number of people who skipped care because of costs, past research has shown.

"I can't tell you right now what the consequences are based on this study, but what we do know from a larger body of work about access to care is that access to care has a huge benefit for health outcomes and mortality," Kyle said.

The findings were published Sept. 9 in Health Services Research.

Numerous barriers

A range of issues can serve as barriers, said Caitlin Donovan, senior director of public relations for the Patient Advocate Foundation. Donovan was not involved in the new study.

For example, many forms are written at a level above the average reading level, Donovan said. They also contain jargon, making them difficult to understand. Rules that people don't know about or understand can be especially costly to them later, such as needing to register for supplemental insurance coverage to pay extra costs while on Medicare, within a strict time frame.

Barriers include not having access to technology or the internet. Conversely, other times it's that a form is in paper and must be delivered to a particular office, Donovan said.

"I don't know how many times we've spoken with patients signing up for something big, like signing up for Medicare or signing up for Medicaid, which is an enormous part of your life, and they get so frustrated with the administration and filling out forms that they never complete it," Donovan said.

The more health care a person needs, the more barriers they'll encounter, Donovan said. It sometimes seems the system is designed for failure, she added.

The Patient Advocate Foundation works to help eliminate obstacles for patients who need health care. Case managers can help people access insurance, transportation, rental assistance and disability benefits. The foundation also offers financial aid.

"So much of what we do is really just help people get through these administrative burdens and they're an enormous barrier to care. Enormous," Donovan said.

Kyle said the reasons why administrative tasks are so challenging could be that medical organizations think more about delivering medical services but not about how departments interact and the flow of information. It's partly fragmentation, but also neglect, she said.

"We don't put as much effort in as we could to make things simpler and easier to understand," Kyle said.

High administrative complexity is a central feature of the U.S. health care system, the study authors noted.

The people who answer phones and schedule appointments have valuable roles, Kyle said, and ensuring their training and compensation would be important.

Equity is another critical issue, Kyle said. Barriers can mean different things to different people.

"For me to make an appointment, it may be annoying, but it's not a prohibitive task. And for other people, it potentially could be," Kyle said.

While concierge services to help people through these situations have been cropping up and can be good, Kyle said, fundamental change is needed.

"It should just be easier to get through the phone system, to get an appointment. It should be easier to understand your bill. Your bill, when you get it, should be correct. I think there's more fundamental solutions before skipping immediately to a work-around," Kyle said.

More information

The U.S. Agency for Healthcare Research and Quality has more on navigating the health care maze.

SOURCES: Michael Anne Kyle, PhD, postdoctoral fellow, department of healthcare policy, Harvard Medical School, Boston, Mass.; Caitlin Donovan, senior director, public relations, Patient Advocate Foundation and National Patient Advocate Foundation, Hampton, Va.; Health Services Research, Sept. 9, 2021