Trickle-Down Burdens: The Effect of Provider Burdens on Clients’ Experience

Abstract

Administrative burden research disproportionately examines micro-level burdens on clients claiming benefits from public agencies. Yet we know little about meso-level burdens on third-party providers making up the submerged state—private actors working on behalf of a public purpose—and what effect these burdens have on services. We draw on interviews, participant observation, and focus groups with substance-use disorder (SUD) service providers to map provider burdens and how they affect services that third parties offer. We supplement the provider perspective with data from clients and their families about their experience with services. We find that providers face significant administrative burdens resulting from federal and state policy; that these burdens affect the quality of the services they are able to offer; and, ultimately, that burdens on providers can trickle down to become burdens on clients. Our research has implications for how we understand administrative burdens, the solutions best suited to reducing them, and the role of burdens as a form of hidden politics in the submerged state.