Administrative Bottlenecks in U.S. Hospital Management: Lessons from Post-Pandemic Workforce Shortages and Bureaucratic Overload

Abstract

Background: U.S. healthcare delivery is characterized by high administrative complexity, which intensified during and after COVID-19 and may differentially burden patients and healthcare-facing roles through appointment coordination, information seeking, paperwork, and billing/insurance problems. Objective: To quantify post-pandemic administrative burden and assess associations with demographic, socioeconomic, role, and insurance characteristics among U.S. adults with continuous coverage. Methods: A cross-sectional analysis used the Health Reform Monitoring Survey (HRMS) administered via Ipsos Knowledge Panel, drawing a nationally representative sample of adults aged 18–64 years with continuous health insurance; the final analytic sample included 4,155 respondents (January 2024–March 2025 fielding window with 12-month recall). Survey-weighted logistic regression estimated adjusted odds ratios (ORs) and predicted probabilities for four administrative domains. Results: Females had higher adjusted odds of frequent appointment coordination (OR 1.85, 95% CI 1.55–2.21) and information gathering (OR 1.42, 95% CI 1.18–1.71). Younger adults had lower odds of appointment coordination versus ages 50–64 (18–34: OR 0.60, 95% CI 0.48–0.75). Higher income was associated with lower information gathering (≥$75,000: OR 0.60, 95% CI 0.48–0.75) and a marked reduction in billing/insurance issues (predicted probability 28.0% vs 45.0% for <$25,000). Public insurance was associated with higher billing/insurance burden (OR 1.55, 95% CI 1.25–1.92). Conclusion: Post-pandemic administrative burden remains substantial and socially patterned, with pronounced inequities by sex, income, and insurance; streamlining administrative processes and reducing billing/coverage friction may yield clinically meaningful improvements in access and system efficiency.