The Effects of Medical-Financial Partnership Interventions on Financial and Health-Related Outcomes: A Systematic Review

Background. As a social determinant of health, poverty affects a person's access to safe housing, healthy foods, employment and educational opportunities, healthcare services, clean air and water, and a safe neighborhood environment. In light of the importance of finances to health, healthcare setting have begun to address financial stress in innovative ways to improve health outcomes. Medical-financial partnerships (MFPs) are being piloted to formally address financial stress and poverty within healthcare settings that serve lower-income and Medicaid-insured patients (Liu et al., 2021), and also encourage keeping healthcare appointments. MFPs are cross-sector collaborations between financial service organizations and health clinics, hospitals, or health systems to implement services that improve both the finances and health of a community, and that directly impact financial stability as part of the healthcare model (Bell et al., 2020; Hole et al., 2017). To date, no systematic review of medical-financial partnership interventions has been conducted to provide evidence of their effectiveness. This paper will fill in the gap by synthesizing effects of medical-financial partnership interventions reported through October 1, 2023.

Method. Systematic review methodology was used for the search, selection, and coding of studies. Meta-analysis quantitatively synthesized effects of interventions. Campbell Collaboration procedures and guidelines for systematic review and meta-analytic methods were used. We searched for and retrieved both published and unpublished studies through a comprehensive search that included multiple electronic databases, conference proceedings, grey literature sources, Google, and Google Scholar using key terms. Reference lists from included studies were harvested for potential studies, and forward citation searching using Google Scholar was conducted. The first authors of the included studies were contacted to request information about unpublished studies, studies in progress and published studies we may have missed.

Results. After locating 66,807 titles and screening 25 full-text titles, our review included four studies reported in five reports; two studies were randomized experiments and two were quasi-experimental. The predominant intervention setting was a pediatric clinic, and free tax preparation was the predominant intervention mode. A range of health and financial outcomes were measured, including financial measures of financial hardship, financial strain, savings amount, income, and tax filing, and health measures of quality of life and health care adherence. Three studies provided sufficient data to calculate effect sizes; however, there were not a sufficient number of studies reporting the same outcomes to quantitatively synthesize effects across studies. Most health and financial effects were small and not statistically significant. One study showed promising outcomes related to care adherence.

Discussion. Overall, the evidence on the effects of MFP interventions for health and financial outcomes is relatively weak, but it is yet difficult to ascertain due to the limited amount and lower quality of evidence identified in this review. Social work practitioners and policy advocates who wish to advance these MFP interventions should support the generation of additional evidence. Practitioners working in this area should collaborate with researchers to design high-quality experimental research on interventions, either independently or in combination, to gather more definitive evidence on these interventions.