What Do We Know about Access to Public Benefits and Services Among Low-Income Families?: A Systematic Review of the Literature

Background and Purpose

In a time of economic crisis following decades of reduced commitments to low-income families, better understanding the obstacles low-income families’ encounter as they attempt to access to public benefits and services is more important than ever. This study offers a systemic review of U.S. research on access to public benefits since 2000. We analyze (1) the types of benefits and services examined in research; (2) the characteristics of the studied populations; and (3) types of barriers identified. We seek a better understanding of how people access a wide array of public benefits and services and the full range of barriers to access.

Methods

We searched ProQuest, Ebsco, Jstor, and Scopus databases from 2000 through 2020 using these search terms: “access to public benefits,” “barrier or fail,” and “empirical or study.” Studies undertaken outside the United States were excluded. This search returned 1,366 articles. All but 300 were eliminated by screening titles and abstracts according to the search criteria, relevance of the subject to access to public benefits, and publication in English. These 300 articles were reviewed in terms of type of access, studied population, and type of barriers examined. A descriptive analysis of these variables followed using SPSS.

Results

Over three-fourths (76.4%) of the studies reviewed focus primarily on access to health care or insurance (e.g. mental health care, HIV services, any health insurance, and Medicaid). 10.7% address community/individual-based services, 8.5% concern housing/employment services, and 8.2% of other services. Most studies focused on samples of general population with a particular physical malady or risk or else on sub-populations with particular characteristics (e.g., specific racial or ethnic minorities, veterans, low-income households). About 27.7% of the studies were based on minority or immigrant samples.

Almost a third of the articles did not address specific barriers to service access, so our analysis of barriers focused on the remaining 202 articles. Barriers included multiple count analysis and most often pertained to disparate individual factors (49.0%) such as limited education, perceptions about caregiver attitudes, stigma, lack of knowledge that a service exists, religious beliefs, and physical/emotional/psychological challenges. Racial/cultural issues (36.2%) and economic factors (20.8%) were next most commonly indicated. The prominence of racial/cultural issues is partially attributable to the common focus on these population in study sampling; over one-fourth (27.7%) of the studies were based on minority or immigrant samples.

Conclusions and Implications

The review shows that health care has dominated empirical work related to understanding factors associated with public benefits access, and that disparate individual factors are likely to affect benefit take-up rates and service use in addition to more institutionally driven program eligibility features. Given that health care is multi-faceted and includes many idiosyncratic delivery features, additional research on access to a broader range of non-health care benefits would be useful. The emphasis of a large subset of studies on minority populations is important; findings suggest that specific racial and immigrant status features, as well as related cultural differences, are particularly important to understand in constructing more accessible programs.