Back

Synergistic barriers to algorithmic recourse in healthcare and administrative systems

Demdiont, A. C.

2026-02-26 health systems and quality improvement
10.64898/2026.02.22.26346836 medRxiv
Show abstract

Algorithmic decision systems mediate access to healthcare, credit, employment and housing, yet individuals who experience adverse decisions face multi-stage barriers when seeking recourse. We formalize these barriers as a series-structured system with 11 empirically parameterized stages across three layers (data integration, data accuracy and institutional access) and prove that single-barrier interventions are bounded by baseline system success. Under baseline parameterization derived from federal datasets and peer-reviewed algorithmic audit studies, end-to-end recourse probability is 0.0018%. Removing any single barrier yields negligible improvement (<0.02%). Factorial decomposition reveals that the three-way cross-layer interaction accounts for 87.6% of achievable improvement, confirmed by Shapley attribution, Sobol sensitivity analysis and bootstrap resampling (n = 1,000). These results provide a structural explanation for the limited impact of incremental reforms and support coordinated multi-layer intervention approaches for clinical AI governance and algorithmic fairness.

Matching journals

The top 6 journals account for 50% of the predicted probability mass.

1
Nature
575 papers in training set
Top 2%
14.8%
2
Nature Human Behaviour
85 papers in training set
Top 0.1%
12.4%
3
Proceedings of the National Academy of Sciences
2130 papers in training set
Top 9%
6.9%
4
PLOS ONE
4510 papers in training set
Top 27%
6.4%
5
Cell Systems
167 papers in training set
Top 2%
4.9%
6
Medical Decision Making
10 papers in training set
Top 0.1%
4.9%
50% of probability mass above
7
Nature Medicine
117 papers in training set
Top 0.5%
4.3%
8
Nature Communications
4913 papers in training set
Top 39%
3.6%
9
Communications Medicine
85 papers in training set
Top 0.1%
3.6%
10
npj Digital Medicine
97 papers in training set
Top 1%
3.3%
11
eLife
5422 papers in training set
Top 30%
2.9%
12
Scientific Reports
3102 papers in training set
Top 47%
2.4%
13
PLOS Digital Health
91 papers in training set
Top 1%
2.1%
14
PLOS Global Public Health
293 papers in training set
Top 3%
1.8%
15
Communications Psychology
20 papers in training set
Top 0.1%
1.7%
16
Science
429 papers in training set
Top 16%
1.2%
17
Canadian Medical Association Journal
15 papers in training set
Top 0.2%
1.1%
18
European Heart Journal - Digital Health
15 papers in training set
Top 0.5%
1.0%
19
PLOS Biology
408 papers in training set
Top 15%
1.0%
20
Journal of the American Medical Informatics Association
61 papers in training set
Top 2%
0.9%
21
Philosophical Transactions of the Royal Society B
51 papers in training set
Top 5%
0.9%
22
Advanced Science
249 papers in training set
Top 18%
0.8%
23
Science Advances
1098 papers in training set
Top 28%
0.8%
24
Nature Genetics
240 papers in training set
Top 7%
0.8%
25
PLOS Computational Biology
1633 papers in training set
Top 25%
0.8%
26
Nature Neuroscience
216 papers in training set
Top 6%
0.8%
27
Biometrics
22 papers in training set
Top 0.2%
0.8%
28
Emerging Infectious Diseases
103 papers in training set
Top 3%
0.6%
29
Computers in Biology and Medicine
120 papers in training set
Top 5%
0.6%
30
Cancers
200 papers in training set
Top 5%
0.6%