Administrative Solutions in Health Reform: Administrative Issues in Expanding Access to Health Care

July 2009 - The U.S. health care system faces well-known challenges: 46 million people without health insurance coverage in 2007, rapidly rising costs that now consume over 16 percent of the nation’s economic output, and uneven and inequitable quality of care.

The National Academy of Public Administration and the National Academy of Social Insurance partnered with the Robert Wood Johnson Foundation to undertake a sweeping analysis of the management and administrative issues that arise in expanding health coverage. The two-year project identified and described core administrative functions that need to be performed regardless of the health system in place, and assessed how these functions might be performed under different health care alternatives. The panel drew lessons from experiences both in the United States and abroad, and recommended administrative and management approaches designed to facilitate the improvement and expansion of health care coverage.

Key Findings

All health care delivery and financing structures raise management challenges. This report will help policymakers identify and consider critical management issues as changes to the health care system are designed and implemented. The panel’s most important conclusion was that the administrative challenges posed by expanding access to health care can be met. Experiences with similar programs in the U.S. and abroad, as well as extensive analyses of specific management issues, provide a wealth of guidance for those responsible for designing and implementing reforms. This report and its accompanying volume showed how those experiences and analyses are relevant to the current debate. The panel made no claims about the best policies and programmatic features to adopt in improving and reforming the nation’s health care system. The panel’s objective instead was to set forth the management considerations that they considered important in the design of an effective program.