Winner of the 2020 Outstanding Book Award Presented by the Public and Nonprofit Section of the National Academy of Management Winner of the 2019 Louis Brownlow Book Award from the National Academy of Public Administration Bureaucracy, confusing paperwork, and complex regulations—or what public policy scholars Pamela Herd and Donald Moynihan call administrative burdens—often introduce delay and frustration into our experiences with government agencies. Administrative burdens diminish the effectiveness of public programs and can even block individuals from fundamental rights like voting. In AdministrativeBurden, Herd and Moynihan document that the administrative burdens citizens regularly encounter in their interactions with the state are not simply unintended byproducts of governance, but the result of deliberate policy choices. Because burdens affect people’s perceptions of government and often perpetuate long-standing inequalities, understanding why administrative burdens exist and how they can be reduced is essential for maintaining a healthy public sector. Through in-depth case studies of federal programs and controversial legislation, the authors show that administrative burdens are the nuts-and-bolts of policy design. Regarding controversial issues such as voter enfranchisement or abortion rights, lawmakers often use administrative burdens to limit access to rights or services they oppose. For instance, legislators have implemented administrative burdens such as complicated registration requirements and strict voter-identification laws to suppress turnout of African American voters. Similarly, the right to an abortion is legally protected, but many states require women seeking abortions to comply with burdens such as mandatory waiting periods, ultrasounds, and scripted counseling. As Herd and Moynihan demonstrate, administrative burdens often disproportionately affect the disadvantaged who lack the resources to deal with the financial and psychological costs of navigating these obstacles. However, policymakers have sometimes reduced administrative burdens or shifted them away from citizens and onto the government. One example is Social Security, which early administrators of the program implemented in the 1930s with the goal of minimizing burdens for beneficiaries. As a result, the take-up rate is about 100 percent because the Social Security Administration keeps track of peoples’ earnings for them, automatically calculates benefits and eligibility, and simply requires an easy online enrollment or visiting one of 1,200 field offices. Making more programs and public services operate this efficiently, the authors argue, requires adoption of a nonpartisan, evidence-based metric for determining when and how to institute administrative burdens, with a bias toward reducing them. By ensuring that the public’s interaction with government is no more onerous than it need be, policymakers and administrators can reduce inequality, boost civic engagement, and build an efficient state that works for all citizens.

Americans are accustomed to anecdotal evidence of the health care crisis. Yet, personal or local stories do not provide a comprehensive nationwide picture of our access to health care. Now, this book offers the long-awaited health equivalent of national economic indicators. This useful volume defines a set of national objectives and identifies indicatorsâ€"measures of utilization and outcomeâ€"that can "sense" when and where problems occur in accessing specific health care services. Using the indicators, the committee presents significant conclusions about the situation today, examining the relationships between access to care and factors such as income, race, ethnic origin, and location. The committee offers recommendations to federal, state, and local agencies for improving data collection and monitoring. This highly readable and well-organized volume will be essential for policymakers, public health officials, insurance companies, hospitals, physicians and nurses, and interested individuals.

The anthrax incidents following the 9/11 terrorist attacks put the spotlight on the nation's public health agencies, placing it under an unprecedented scrutiny that added new dimensions to the complex issues considered in this report. The Future of the Public's Health in the 21st Century reaffirms the vision of Healthy People 2010, and outlines a systems approach to assuring the nation's health in practice, research, and policy. This approach focuses on joining the unique resources and perspectives of diverse sectors and entities and challenges these groups to work in a concerted, strategic way to promote and protect the public's health. Focusing on diverse partnerships as the framework for public health, the book discusses: The need for a shift from an individual to a population-based approach in practice, research, policy, and community engagement. The status of the governmental public health infrastructure and what needs to be improved, including its interface with the health care delivery system. The roles nongovernment actors, such as academia, business, local communities and the media can play in creating a healthy nation. Providing an accessible analysis, this book will be important to public health policy-makers and practitioners, business and community leaders, health advocates, educators and journalists.

The United States has the highest per capita spending on health care of any industrialized nation but continually lags behind other nations in health care outcomes including life expectancy and infant mortality. National health expenditures are projected to exceed $2.5 trillion in 2009. Given healthcare's direct impact on the economy, there is a critical need to control health care spending. According to The Health Imperative: Lowering Costs and Improving Outcomes, the costs of health care have strained the federal budget, and negatively affected state governments, the private sector and individuals. Healthcare expenditures have restricted the ability of state and local governments to fund other priorities and have contributed to slowing growth in wages and jobs in the private sector. Moreover, the number of uninsured has risen from 45.7 million in 2007 to 46.3 million in 2008. The Health Imperative: Lowering Costs and Improving Outcomes identifies a number of factors driving expenditure growth including scientific uncertainty, perverse economic and practice incentives, system fragmentation, lack of patient involvement, and under-investment in population health. Experts discussed key levers for catalyzing transformation of the delivery system. A few included streamlined health insurance regulation, administrative simplification and clarification and quality and consistency in treatment. The book is an excellent guide for policymakers at all levels of government, as well as private sector healthcare workers.

Countries could potentially spend significantly less on health care with no impact on health system performance, or on health outcomes. This report reviews strategies put in place by countries to limit ineffective spending and waste.

The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.

The balance between state and federal health care financing for low-income people has been a matter of considerable debate for the last 40 years. Some argue for a greater federal role, others for more devolution of responsibility to the states. Medicaid, the backbone of the system, has been plagued by an array of problems that have made it unpopular and difficult to use to extend health care coverage. In recent years, waivers have given the states the flexibility to change many features of their Medicaid programs; moreover, the states have considerable flexibility to in establishing State Children's Health Insurance Programs. This book examines the record on the changing health safety net. How well have states done in providing acute and long-term care services to low-income populations? How have they responded to financial incentives and federal regulatory requirements? How innovative have they been? Contributing authors include Donald J. Boyd, Randall R. Bovbjerg, Teresa A. Coughlin, Ian Hill, Michael Housman, Robert E. Hurley, Marilyn Moon, Mary Beth Pohl, Jane Tilly, and Stephen Zuckerman.