Administrative Burdens in Healthcare Through Pillars of Race, Gender, Immigration Status, and Religion: A Literature Review

The literature review examines how administrative burdens within the United States healthcare system function as systemic barriers that reinforce existing inequities, utilizing Herd & Moynihan’s framework of learning, psychological, and compliance costs. The purpose of this paper is to synthesize how facially neutral “red tape” disproportionately marginalizes vulnerable populations by redistributing vital health resources to favored demographics. Methodologically, the review integrates empirical data, public policy research, and legal frameworks primarily from the 2010s and 2020s across four primary axes of identity: race, gender, immigration status, and religion. By applying Racialized Organization Theory, Feminist State Theory, and Policy Feedback Theory, the review tracks how structural barriers manifest across disparate circumstances. The findings conclude that administrative burdens effectively transform essential public resources into instruments of discrimination, validating Policy Feedback Theory by demonstrating that compounded institutional friction causes systemic service avoidance; finally, the paper identifies critical gaps in existing research regarding religious identity in public administration data and recommends future scholarship to transition from solely documenting disparities to evaluating successful mitigation strategies.