The Hidden “Friction Tax”

Health innovation loves the language of efficiency: faster, smarter, automated, digital, self-service and AI-enabled. Those words open doors to opportunity because they promise to make health work better for the people who deliver and receive care.

However, there is a question we rarely ask when introducing a new technology, administrative requirement or checkpoint process into health: “Did we actually eliminate work, or did we simply kick the can down the road and move it to someone else?”

Too often, what looks like efficiency on one side of the health ecosystem table is experienced as friction on the other. The insurer automates a process while a physician practice hires someone to navigate it. The hospital creates another digital portal, while the patient becomes responsible for connecting information that the health system has failed to connect with another. New technology promises to give clinicians time back, only to add another inbox, alert, or screen demanding attention.

In Healing the Sick Care System: Why People Matter, I describe fragmentation as one of the forces that separates people from the care they need and health professionals from the people they are trying to help. Friction is what that fragmentation feels like in our day-to-day life. It is the extra call, the repeated form, the missing information, the wasted hour and the handoff nobody owns. Worse, it is the yelling and arguing between the patient’s physician and the payer’s prior authorization approval team.

There is a cost to all of this. Call it the friction tax.

The Work Did Not Disappear

Prior authorization offers one of the clearest examples. It is intended to control unnecessary spending and encourage appropriate use of diagnostics and treatments. Those are legitimate, responsible goals. The problem amplifies when the administrative mechanism created to save money begins consuming enormous resources elsewhere.

The American Medical Association reported in 2026 that physicians and their staff spend an average of 13 hours each week completing prior authorization requirements. Physicians average about 40 authorization requests each week and 40 percent report having staff who work exclusively on prior authorization.

That work is not free. Its cost simply moved.

An insurer’s utilization decision results in forms, electronic submissions, phone calls, appeals, and follow-up work within a physician practice. Even when the authorization is eventually approved, someone has paid the friction tax. The patient may pay another portion through delayed treatment or by exhausting the effort required to fight for something a clinician has already determined to be necessary. In rare but tragic cases, the friction does not merely delay care. It helps determine whether care arrives in time.

We celebrate efficiency where it was created, without always counting the burden it created elsewhere.

When Waiting Becomes a Bill

Consider something far more ordinary: waiting for the doctor.

Physicians run late. Medicine is unpredictable and sometimes the person in the examination room needs more time than anyone anticipated. That is not friction. The friction is knowing the doctor is running 30, 60 or 90 minutes behind and failing to tell the next patient.

The technology needed to send a text saying, “Dr. Smith is running about 45 minutes late. Please adjust your arrival time,” is hardly futuristic. Airlines alert us when our flights are delayed. Restaurant buzzers tell us when a table is ready. A delivery app can show us a sandwich moving across town. Even items ordered from other countries have shopper apps to keep us posted on their global journeys.

Yet people still leave work, arrange childcare, drive to a physician’s office and sit for an hour because nobody communicated information the practice already knew. This is where a simple principle becomes very practical: communication is care. A timely message respects someone’s time, reduces anxiety and helps strengthen ties before the health encounter even begins.

People’s time has economic value. A national study published in The American Journal of Managed Care found that an ambulatory medical visit lasted an average of 121 minutes, including 37 minutes of travel and 84 minutes at the clinic. Researchers estimated the opportunity cost at $43 per visit in 2010, totaling approximately $52 billion annually across the United States. For every dollar spent reimbursing a physician visit, patients absorbed another 15 cents in the value of their time.

Those figures are more than a decade old; however, the principle is not. Every unnecessary 30 or 60 minutes has value, particularly for the hourly worker losing wages, the parent paying for childcare, the caregiver juggling another person’s needs or anyone forced to surrender a piece of the workday because a practice did not communicate.

According to the American Family Physician, 10 million patients visited a primary care physician this week. Multiply that experience across millions of appointments and waiting stops being a minor annoyance. It becomes an enormous invisible expense.

People Eventually Route Around Friction

There is another consequence to inconvenience that cannot be measured only in dollars. People change their behavior using their buying power.

Urgent care centers and retail clinics offer something traditional medicine too often lacks: walk-in availability, extended hours and shorter waits. Research examining retail clinic use has repeatedly identified convenience as an important reason patients choose these settings.

That matters because people eventually route around friction.

The growth of convenient care cannot be attributed to waiting rooms alone. Primary care shortages, appointment availability, location, cost and changing consumer expectations all played roles. Yet convenience became a competitive advantage because traditional primary care frequently asked patients to organize their lives around the system rather than designing the system around people’s lives.

The loss can be subtle. A walk-in clinic can treat a sore throat or an infection just as efficiently. What it cannot always replace is the long-standing relationship with a primary care professional who has known the patient over the years, notices changes, encourages prevention, and connects today’s complaint to yesterday’s history.

The convenient alternative solved a friction problem. It did not necessarily replace everything that was lost.

Health Professionals Pay Attention

The friction tax also falls heavily on health professionals.

A time-and-motion study published in Annals of Internal Medicine found that for every hour physicians spent in direct clinical face time with patients, they spent nearly two additional hours on electronic health records and desk work during the workday. Physicians also reported another one to two hours of personal time each night devoted largely to EHR tasks.

Some of that work is essential. Documentation protects patients. Medication reconciliation matters. Reviewing laboratory results matters. Safety checks matter.  The goal should never be completely frictionless medicine because some friction protects people from harm.

The problem is friction without corresponding value: entering information that already exists, moving data between systems that cannot communicate, clicking through low-value alerts or requiring highly trained clinicians to perform tasks that do not require their expertise.  How many times have you entered a doctor’s office and been greeted with a clipboard with papers on your medical history?

Every unnecessary minute has an opportunity cost. It is time unavailable for examining someone, explaining a diagnosis, listening to a family or simply looking another human being in the eye. When process begins consuming the relationship, efficiency has defeated its own purpose.

Families Have Become the Integration Layer

Another group quietly absorbs enormous friction: family and friend caregivers.

When organizations cannot coordinate, close connections often coordinate for them. They maintain medication lists, arrange appointments, call insurers, locate specialists, monitor portals, manage bills, and relay information from one clinician to another.

AARP estimated in 2026 that 59 million family caregivers provided 49.5 billion hours of unpaid care annually, work valued at approximately $1.01 trillion.

Not all of that time represents administrative friction. Much of caregiving is essential, personal and deeply human. Yet some portion exists because families have become the connective tissue between organizations and professionals that do not consistently connect.

We have created millions of unpaid care coordinators and rarely count their time as part of the cost of care.

Start Asking Who Pays

None of this is an argument against technology, utilization management or administrative oversight. Innovation can remove enormous amounts of friction. The challenge is determining whether it actually did.

Before introducing a new process or technology, health system innovators should ask: “How many steps does this remove? How many does it add? Whose time does it save? Whose time does it consume? What new work does it create? What happens to the person who lacks the time, digital skills, financial resources or family support to navigate it?”

Eventually, those questions should become measurable. They mean even push the fragmented health ecosystem to share and prioritize a common metric: patient and health professional experience.

Imagine evaluating innovation not only by clinical benefit and financial return but also by a friction score that measures time, clicks, handoffs, repeated information requests, administrative hours, delays, and work transferred to patients and caregivers.

A sick care system is not healed simply by adding more technology. It becomes healthier when innovation reconnects people, information and care rather than placing another obstacle between them.

The next great advance in health may not come solely from adding something new. It may come from finally recognizing the cost of everything we have already added. When a system saves itself time by consuming someone else’s, it has not eliminated cost. It has simply sent the bill to someone who cannot invoice it back.