Some programs, like schools, dispense services rather than cash. If you're talking about direct payment programs these are extremely efficient: 4.5% for SCHIP

Some programs, like schools, dispense services rather than cash. If you're talking about direct payment programs these are extremely efficient: 4.5% for SCHIP in 2005, for example. Other direct payment programs have higher overhead because they are means-tested (another conservative victory) and it costs money to administer means-tested programs. Amusingly, the US state of Florida in 2011 enacted another one of those republican favorites, the drug test for welfare recipients. In practice it cost more to administer the drug tests than they saved by throwing the positive results out of the program, because it turns out that welfare recipients are far less likely than the general public to use drugs.