ORCID
0009-0008-2380-4585
Date of Award
Summer 2025
Language
English
Embargo Period
7-29-2025
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
College/School/Department
Department of Public Administration and Policy
Program
Public Administration and Policy
First Advisor
Ashley M. Fox
Committee Members
Patricia Strach; Kayla Schwoerer
Keywords
Medicaid, Administrative burden, Policy feedback
Subject Categories
Health Policy | Public Administration | Public Affairs, Public Policy and Public Administration | Public Policy
Abstract
Why do governments favor contracting out social services? Do private actors guarantee a better service experience for citizens? How should we understand the trade-off between efficiency and high-quality service delivery? These are the central questions that motivate this dissertation. Focusing on Medicaid, one of the largest social safety net programs in the United States, this dissertation investigates the impact of outsourcing Medicaid delivery to private health insurance companies. It explores how this privatized structure generates administrative burdens and shapes policy feedback effects. Theoretically, this project seeks to bridge the administrative burden and policy feedback literature by examining how burdensome policy experiences influence individuals’ political engagement. Employing a mixed-methods approach, this dissertation combines causal inference techniques, in-depth interviews with health Navigators and a nationally representative survey experiment.
In sum, this dissertation finds that outsourcing social services does not necessarily improve access or service quality. Although contracting out is often introduced to enhance efficiency in public programs, private actors may achieve cost reductions by restricting access to services. Additionally, the research shows that private service providers can impose further administrative burdens when Medicaid beneficiaries seek care. By exercising bureaucratic discretion as a form of “hidden politics,” private entities shape how individuals experience and interact with government programs. Moreover, respondents perceived higher administrative burdens when the service provider was private, and greater burdens were associated with increased political engagement. These findings suggest that both the type and source of administrative burden play a critical role in shaping political behavior.
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Recommended Citation
Jeong, Soyun, "The Invisible Costs of Privatizing Welfare: Administrative Burdens in Contracted Medicaid" (2025). Electronic Theses & Dissertations (2024 - present). 272.
https://scholarsarchive.library.albany.edu/etd/272