• Administrative burden shows up through learning, compliance, and psychological costs, restricting access because many systems require people to clear too many checkpoints and navigate fragmented services.
• Nudges and ex parte renewal reduce checkpoint losses by helping people clear required steps more easily and by cutting back on repeated renewal demands when eligibility likely hasn’t changed.
• “No wrong door” approaches and warm handoffs can reduce fragmentation by making first contact less costly and transfers more supported, so the person relying on the service is less often left balancing the whole process alone.

To understand administrative burden, it helps to define it through three types of costs: learning costs, which arise when people have to figure out whether a service exists, whether they qualify, and where they’re supposed to begin, compliance costs, which come with forms, documentation, appointments, and repeated proof of eligibility, and psychological costs, which include stress, shame, irritation, and unease that can build when working with public authorities.¹

Administrative burdens often reinforce inequity through three primary mechanisms.² The first is reduced reach. Programs that were built to alleviate the effects of poverty, improve health, or widen access to other social services can only do that if people can get through the front end, and once learning costs, compliance costs, and psychological costs accrue, a service may exist on paper while becoming far less reachable in practice. 

The second mechanism is unequal targeting. Within the same benefit system, some groups are often met with more forms, more documentation demands, more audits, and more discretionary scrutiny, which means the administrative load isn’t being distributed evenly and may be tracking ideas about who is seen as deserving, credible, or risky. 

Third, administrative burden reinforces inequity through political vulnerability. Groups with less institutional power may be more exposed to burdens from the start, and over time those burdens reflect broader patterns of racism, sexism, ableism, and exclusion rather than neutral public administration.²

In the United States, those mechanisms have appeared across both historical and recent cases. For example, after 1898 in Louisiana, Black citizens were formally entitled to vote, yet literacy tests, poll taxes, property requirements, and uneven enforcement were used to make registration far harder in practice.³ More recently, heavier administrative burdens have been linked to lower take up of federal student loan repayment plans in lower income and higher-percentage Black neighborhoods, more documentation-based denials after Hurricane Katrina, and larger losses in children’s public health insurance among Hispanic families and families facing citizenship or education barriers.^2,4,5 One way to reduce this administrative burden is through easing checkpoints, simplifying renewals, and repairing fragmented service pathways.

An administrative checkpoint is a required step that must be completed for a case to move forward. If it isn’t completed, the process can stall, close, or end in denial. A long wait time or a confusing website may be frustrating for the user, but they don’t always produce a hard stop. A missed interview can, as can a document deadline, a recertification appointment, a proof of income request, or a missing identity document. These steps may look routine on the administrative side, and each step may seem reasonable on its own, but once they’re stacked together, access may be dependent on whether people can keep moving through the chain without a single break.

These checkpoints don’t screen only for eligibility. They can also screen for time, stability, transportation, phone access, digital access, document storage, bureaucratic fluency, and the ability to recover from small failures while everything else in life is still going on. A person who has steady housing, flexible work, reliable internet, and a folder full of records is more likely to get through these hurdles. However, someone who’s juggling care, work, unstable housing, a disability, limited English, or unreliable transportation systems might not. The checkpoint looks the same on paper for both, but its real burden isn’t at all.

A San Francisco observational study of roughly 40,000 Supplemental Nutrition Assistance Program (SNAP) recertification cases found that interview timing could change whether people stayed connected to food assistance.⁶ SNAP is the primary food assistance program for low-income households in the United States, and recipients are required to complete a recertification interview to keep their benefits. 

In the study, interview dates were assigned across the month, and although recipients could reschedule, they’d still have to complete the full process by the end of that same month. That meant people assigned to later interviews had less time to recover from a missed call, gather income documents, or sort out a paperwork problem. The researchers found that people whose cases were assigned to interviews at the end of the month were 10% less likely to recertify than cases assigned to interviews at the start of the month. They also found that those with interviews at the end of the month were less likely to participate in SNAP at any point during the following year. 
Another kind of checkpoint sits further upstream, before someone even gets to apply for many services. In a number of countries, access to federal services depends on being formally registered in population systems and having documents that prove who you are and where you live, such as an official identity card or a registered residential address.¹ If a person can’t complete that registration step, or can’t maintain the documents tied to it, public systems may not recognize them as a legitimate claimant at all. For people experiencing housing instability, migration-related precarity, or repeated displacement, that can become a devastating bottleneck since proving residence, maintaining records, or keeping documents safe may be far tougher than the system assumes. Missing that checkpoint then leads to a major fallout that can spill into health insurance, education, social benefits, banking, housing, employment, and voting. Scholars describe this as a cascade of exclusion because one blocked point of recognition can trigger multiple downstream losses.¹

Administrative checkpoints won’t always require the same solution because some bottlenecks come from confusion and poor timing while others come from asking people to re-confirm their eligibility when the state may already have enough information to move forward. Behavioral science can help on both fronts, first by making required steps easier to understand and complete, and then by reducing how often people have to clear those steps overall.

Nudges Can Help People Clear Checkpoints, but They Can’t Carry the Whole Load

In the same SNAP setting described above, where interview timing changed who stayed connected to food assistance, there’s also evidence that lighter touch design can improve follow-through. One field experiment with 1,554 SNAP applicants tested a fairly simple change. On top of the standard mailed reminder, applicants in the treatment group also received informational nudges in the form of text messages explaining that the interview was required and that they could use a more flexible “interview anytime” option. 

That extra detail led to interview completion rates that were 10% higher, approval rates that were 7% higher, and interview completion that came 3 to 4 days sooner than in the control group. Follow-up survey evidence suggested the intervention worked in part because applicants were more aware that the interview was mandatory and felt clearer on what they were supposed to do, reducing learning costs overall. 

Still, there’s a ceiling effect to the extent that nudges can do. Nudges can make a burdensome process easier to navigate, and that’s definitely worth something, but they don’t remove the checkpoint, nor do they change the fact that one missed step may still be enough to knock an eligible person out.

Ex Parte Renewal Can Reduce How Many Checkpoints People Face

Ex parte renewal could ease burden in a more structural way because it changes who has to act at renewal. Instead of sending every beneficiary back through another form, another signature, and another round of document gathering, the agency first checks the case file and approved administrative data sources it already has access to, and only if something is missing, inconsistent, or materially changed does the person get asked to do more. In the United States, Medicaid and the Children’s Health Insurance Program require states to attempt renewal this way first, and federal guidance says they may not require a new renewal form, a new signature, or extra attestations when eligibility can already be confirmed from available data.⁷ 

This approach can save time on both sides of the desk. For beneficiaries, it may mean one less form to decode, one less deadline to track, and one less chance of losing coverage over paperwork even though eligibility hadn’t actually changed. For agencies, it could reduce churn and free up staff time that would otherwise be spent processing avoidable renewals, chasing missing forms, reopening cases, and cleaning up procedural losses that didn’t reflect a real change in need or eligibility. 

Canada already uses similar logic with the Guaranteed Income Supplement, a monthly payment for seniors belonging to a low socioeconomic background receiving Old Age Security.⁸ Service Canada reported that 96% of Guaranteed Income Supplement (GIS) benefits were renewed automatically in 2021, and federal materials explain that when income information is already available, entitlement is reassessed and benefits continue without forcing most seniors into another claimant driven renewal cycle.⁹ 

This approach can be applied similarly across other countries as well, for example, in England and Wales with Personal Independence Payment (PIP), a disability benefit for people aged 16 and over whose long-term physical or mental health condition affects daily living or mobility.10 Before an award ends, and if applicants are still eligible for a payment the following cycle, claimants are sent a review form, which they must complete and return, and if more information is needed, they may be contacted by a health professional or asked to attend another assessment in person, by phone, or by video. 

The review load is substantial, and that’s where the ex parte structure can lead to fewer unnecessary reassessments. In the quarter ending April 2025, there were 130,000 planned award reviews recorded and 150,000 cleared in England and Wales, and across the five years from May 2020 to April 2025, 76% of planned award reviews ended with either no change or an increase in the claimant’s award.10 With most planned award reviews ending in no change, an ex parte first pass could spare a fair number of claimants from undergoing another full review cycle.

A person’s problem rarely arrives in pieces, but public services often do. Someone who loses work may need income support, food assistance, housing help, childcare help, and health coverage at roughly the same time, but frequently, those needs are routed through separate programs, portals, rules, and timelines. One office may ask for proof that another office already has, one approval may depend on a different department moving first, and one missed handoff can throw the whole process off balance. The result is that people are left stitching together what the system has split apart.

Health care makes fragmentation especially visible, because a patient may be bounced from a family doctor to a specialist, from the specialist to an insurer, and from the insurer back to the clinic, all before treatment is even scheduled. A 2025 scoping review reported that learning costs are especially prominent in the care-seeking phase of patient administrative burden, where people have to figure out which treatment option aligns best with their needs, understand insurance coverage, estimate out-of-pocket costs, identify in-network providers, and secure prior authorizations before care can even move forward.¹¹ 

Scheduling can also become a headache; the review provided secret shopper evidence showing how hard it may be to establish care, with more than 70% of calls in one study failing to secure a new patient primary care or urgent care appointment. These tasks can create a maze where patients are left to function as benefits experts, schedulers, and claims navigators, all at once.

Similarly, in cancer care, delays, broken handoffs, and poorly aligned administrative steps can carry much heavier consequences once care is urgent. The President’s Cancer Panel wrote in its 2024 report that the U.S. health care system is fragmented and that this fragmentation produces major unnecessary delays and inefficient delivery of care, while also highlighting that this burden isn’t evenly distributed across the population.¹² 

People of color, rural populations, people with fewer economic resources, LGBTQ+ people, and people with disabilities are much more likely to face worse access and worse outcomes, so administrative disconnection can deepen inequality at the same time that it slows care down. A system may contain excellent clinicians and still lead to a negative experience for patients if referrals, authorizations, records, appointments, and follow-up don’t line up when people need them to.

There’s another issue embedded in this kind of design, and it’s tied to ownership and accountability. Once a person’s care or claim is spread across several agencies, insurers, providers, or administrative units, no single actor clearly owns the whole route from start to finish. Scholars often describe this as a “problem of many hands,” where responsibility is shared across multiple actors and blame can become easier to deflect if something goes wrong or gets delayed.¹ 

When systems are fragmented, problems can arise at the front door, meaning the point where someone first asks for help, and can arise again at the side door, meaning the point where one service passes that person to another. People shouldn’t have to know the internal map of a government to get help, and they shouldn’t be left carrying the transfer, retelling their story, and trying to keep the next connection alive on their own once they’ve reached one legitimate service.

No Wrong Door Can Make Entry Less Punishing

At the front door, fragmentation can make an ordinary first move do far too much work, because a wrong number, a wrong office, or a wrong webpage may trigger another form, another delay, another retelling, and another chance to lose momentum before help has really begun. A “no wrong door” design eases that burden by treating any reasonable first contact as enough to start, so the person doesn’t have to solve the system before the system starts helping.¹³ That’s also a change in choice architecture, because it makes the first choice less punishing. 

In a fragmented system, people may have to pick the right office, hotline, or service category before they’ve even entered the system properly, and a wrong pick can cost time and momentum. A “no wrong door” model changes that setup by making a reasonable first contact enough to begin, while the system takes on more of the work of routing the person to the right support. That fits bounded rationality as well, because people under stress tend to rely on shortcuts and workable guesses rather than carefully comparing every possible path. 

Canada’s response to addressing homelessness offers one example of this approach at work. The Reaching Home Coordinated Access Guide, published by the Government of Canada to support communities across Canada, describes what happens without coordination as a “complicated web” of connected but uncoordinated services in which people may have to tell their story multiple times and put themselves on multiple waiting lists.¹⁴ 

The guide defines a no wrong door approach as one in which clients are appropriately served regardless of which location they access or hotline they call within the housing and homelessness response system, and it describes coordinated access as a way to use common triage and assessment practices so people can be matched to resources more consistently, regardless of where they enter. That could mean someone first walks into a shelter because it’s open and visible, even though they also need employment support, psychiatric care, and other services, and the system is designed to route them onward through a shared pathway instead of making that first contact a costly wrong turn. 

Warm Handoffs Can Reduce What Happens Between Doors

The side door is a different weak point, and it shows up after someone has already found one service. A warm handoff means the first service stays involved in the transfer rather than effectively saying, call this other place and see what happens, so the introduction, connection, or transfer is actively supported, and more of the coordination work remains inside the system instead of bouncing back onto the person seeking help.¹⁵

For example, a one-year quality improvement study in a large urban pediatric primary care practice looked at what happened when clinicians increased warm handoffs to behavioral health providers, meaning the primary care provider introduced the child or family to the behavioral health provider during the same visit instead of sending them away with a referral to chase later.¹⁶ As warm handoffs rose from 18% to 37%, follow-up rates were markedly higher for referred patients who received one, 73.1% compared with 49.5% for those who did not. 

A cold referral doesn’t remove coordination work, it redistributes it, so the person still must place another call, repeat their history, sort through another intake process, and work out whether the next service can even take them, all after the first provider has already stepped back. In contrast, a warm handoff switches more of that labor into the system, which could reduce all three costs in administrative burden, and make follow-through less dependent on whether the user has enough time, clarity, and stamina to keep carrying the case forward alone.

Even well-designed reforms can stall in implementation, because reducing administrative burden often means shifting coordination, sorting, and transferring work from users back into institutions. Making entry easier and handoffs more reliable may require shared intake practices, aligned portal and website design, compatible data systems, cross-agency cooperation, and staff training that takes time, money, and management attention. Those changes rarely happen quickly, and the investment is usually felt before the gains are.

Scarcity creates a second limit. It’s one thing to help people reach the right service more easily or move between services with less friction. It’s another to ensure there’s actually a housing unit, therapist, caseworker, or benefit slot available once they get there. If downstream capacity is already stretched thin, better navigation may simply move more people into the same bottleneck, and improvements in follow-through may put additional pressure on services that were already overextended.

Administrative burden across public services can block eligible people from getting help, keeping benefits, or staying connected to care. In many systems, access is narrowed by renewal rules, document requests, missed deadlines, and service pathways that are hard to follow when life is already unstable. Some of the strongest opportunities draw on decision science ideas that can reduce administrative burden while preserving program integrity. 

Nudges could improve follow-through by making required steps, deadlines, and renewal actions easier to notice and act on at the right time, while ex parte renewal may reduce avoidable paperwork by allowing agencies to confirm eligibility through existing administrative data before asking people to complete another round of forms. No wrong door models, paired with warm handoffs, could also ease the burden created by fragmented public services, because people may be less likely to lose access when entry points are more forgiving and transfers are actively supported rather than left hanging.

At The Decision Lab, we work with public institutions and service organizations that are striving to reduce administrative burden, looking at where eligible people fall out, which rules or processes are creating the biggest barriers, and which changes may improve access without creating a different problem somewhere else. If your team is trying to make public services easier to reach, easier to complete, and easier to stay connected to, we’d be happy to work together.

Sludge

While nudges try to encourage better decisions by making some choices easier than others, sludge makes a process harder by adding friction, which makes people less likely to continue, whether that means claiming a rebate or applying for a tax credit. Read on to learn about its effects on consumerism and politics, and to see whether sludge can ever be used for good.

Encouraging Patient-Doctor Visits

Across health systems, the hardest problem sometimes isn’t getting patients in the door, it’s keeping them there. Many people still postpone visits, because care can feel inaccessible, time-consuming, stigmatizing, or emotionally draining. This article offers behavioral design tips for getting patients in and keeping them engaged.

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3. Keele, L., Cubbison, W., & White, I. (2021). Suppressing Black votes: A historical case study of voting restrictions in Louisiana. American Political Science Review, 115(2), 694-700. https://doi.org/10.1017/S0003055421000034
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7. Centers for Medicare & Medicaid Services. (2024, November 26). Basic requirements for conducting ex parte renewals of Medicaid and CHIP eligibility (CMCS Informational Bulletin). U.S. Department of Health & Human Services. https://www.medicaid.gov/federal-policy-guidance/downloads/cib11262024.pdf
8. Government of Canada. (n.d.). Guaranteed Income Supplement. https://www.canada.ca/en/services/benefits/publicpensions/old-age-security/guaranteed-income-supplement.html
9. Employment and Social Development Canada. (2022, March 30). Question period note: Guaranteed Income Supplement (GIS) – yearly renewal. Government of Canada. https://search.open.canada.ca/qpnotes/record/esdc-edsc%2CSeniors-JUN2022-008
10. Department for Work and Pensions. (2025, September 9). Personal Independence Payment statistics to April 2025. GOV.UK. https://www.gov.uk/government/statistics/personal-independence-payment-statistics-to-april-2025/personal-independence-payment-statistics-to-april-2025
11. Kyle, M. A., Feng, K. Y., Wade, C. G., & Yaver, M. (2025). Patient administrative burden: A scoping review. Health Affairs Scholar, 3(11), qxaf216. https://doi.org/10.1093/haschl/qxaf216
12. President’s Cancer Panel. (2024, November). Enhancing patient navigation with technology to improve equity in cancer care: A report to the president of the United States from the President’s Cancer Panel. https://prescancerpanel.cancer.gov/reports-meetings/enhancing-patient-navigation-2024
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14. Employment and Social Development Canada. (2019). Reaching Home coordinated access guide. Government of Canada. https://homelessnesslearninghub.ca/wp-content/uploads/2021/06/HPD_ReachingHomeCoordinatedAccessGuide_EN_20191030-1.pdf
15. Taylor, R. M., & Minkovitz, C. S. (2021). Warm handoffs for improving client receipt of services: A systematic review. Maternal and Child Health Journal, 25(4), 528–541. https://doi.org/10.1007/s10995-020-03057-4 
16. Germán, M., Hsu-Walklet, T., Gurney, B. A., Parekh, J., Berman, R. S., Herrick, J., Briggs, R. D., Aviv, E. C., & Faro, E. Z. (2020). “Nice to Meet You”: A quality improvement project to increase warm handoffs. Clinical Practice in Pediatric Psychology, 8(3), 247–256. https://doi.org/10.1037/cpp0000357