Advertisement

Medical-Financial Partnerships: Cross-Sector Collaborations Between Medical and Financial Services to Improve Health

Published:October 13, 2019DOI:https://doi.org/10.1016/j.acap.2019.10.001

      Abstract

      Financial stress is the root cause of many adverse health outcomes among poor and low-income children and their families, yet few clinical interventions have been developed to improve health by directly addressing patient and family finances. Medical-Financial Partnerships (MFPs) are novel cross-sector collaborations in which health care systems and financial service organizations work collaboratively to improve health by reducing patient financial stress, primarily in low-income communities. Financial services provided by MFPs include individually tailored financial coaching, free tax preparation, budgeting, debt reduction, savings support, and job assistance, among others. MFPs have been shown to improve finances and, in the few existing studies available, health outcomes. We describe the rationale for MFPs and examine 8 established MFPs providing financial services under 1 of 3 models: full-scope on-site service partnerships; targeted on-site service partnerships; and partnerships facilitating referral to off-site financial services. The services MFPs provide complement clinical social risk screening and navigation programs by preventing or repairing common financial problems that would otherwise lead to poverty-related social needs, such as food and housing insecurity. We identify common themes, as well as unique strengths and solutions to a variety of implementation challenges MFPs commonly encounter. Given that the financial circumstances and health outcomes of socially marginalized patients and families are closely linked, MFPs represent a promising and feasible cross-sector service delivery approach and a new model for upstream health care to promote synergistic financial well-being and health improvement.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. World Health Organization (WHO). Social Determinants of Health – Key Concepts. WHO website.http://www.who.int/social_determinants/thecommission/finalreport/key_concepts/en. Accessed 16 June 2017.

        • Schickedanz A
        • Dreyer BP
        • Halfon N
        Childhood poverty: understanding and preventing the adverse impacts of a most-prevalent risk to pediatric health and well-being.
        Pediatr Clin North Am. 2015; 62: 1111-1135https://doi.org/10.1016/j.pcl.2015.05.008
        • Avendano M
        • Glymour MM
        • Banks J
        • et al.
        Health disadvantages in US adults aged 50 to 74 years: a comparison of the health of rich and poor Americans with that of Europeans.
        Am J Public Health. 2009; 99: 540-548https://doi.org/10.2105/AJPH.2008.139469
        • Collins SR
        • Rasmussen PW
        • Doty MM
        • et al.
        The rise in health care coverage and affordability since health reform took effect: findings from the Commonwealth Fund Biennial Health Insurance Survey, 2014.
        Commonwealth Fund Issue Brief. 2015; 2: 1-16
        • Hamel L
        • Norton M
        • Pollitz K
        • et al.
        The burden of medical debt: results from the Kaiser Family Foundation/New York Times Medical Bills survey.
        2016
        • Dzau VJ
        • McClellan M
        • McGinnis JM
        Vital directions for health and health care: an initiative of the National Academy of Medicine.
        JAMA. 2016; 316: 711-712https://doi.org/10.1001/jama/2016.10692
        • Duffee JH
        • Kuo AA
        • Gitterman BA
        Poverty and child health in the United States. American Academy of Pediatrics Policy Statement.
        Pediatrics. 2016; 137https://doi.org/10.1542/peds.2016-0339
        • Czapp P
        • Kovach K
        Poverty and health—the family medicine perspective (position paper).
        Am Acad Fam Physicians Policy Statement. 2015;
        • Braveman PA
        • Cubbin C
        • Egerter S
        • et al.
        Socioeconomic disparities in health in the United Stated: what the patterns tell us.
        Am J Public Health. 2010; 14: 20-35https://doi.org/10.2105/AJPH.2009.166082
        • Aittomaki A
        • Martikainen P
        • Laakosonen M
        • et al.
        The associations of household wealth and income with self-reported health—a study on economic advantage in middle-aged Finnish men and women.
        Soc Sci Med. 2010; 71: 1018-1026https://doi.org/10.1016/j.socscimed.2010.05.040
        • Demakakos P
        • Marmot M
        • Steptoe A
        Socioeconomic position and the incidence of type 2 diabetes: the ELSA study.
        Eur J Epidemiol. 2012; 27: 367-378https://doi.org/10.1007/s10654-012-9688-4
        • Hajat A
        • Kaufman JS
        • Rose KM
        • et al.
        Do the wealthy have a health advantage? Cardiovascular disease risk factors and wealth.
        Soc Sci Med. 2010; 71: 1935-1942https://doi.org/10.1016/j.socscimed.2010.09.027
        • Munster E
        • Ruger H
        • Ochsmann E
        • et al.
        Over-indebtedness as a marker of socioeconomic status and its association with obesity: a cross-sectional study.
        BMC Public Health. 2009; 9: 286https://doi.org/10.1186/1471-2458-9-286
        • Yilmazer T
        • Babiarz P
        • Liu F
        The impact of diminished housing wealth on health in the United States: evidence from the great recession.
        Soc Sci Med. 2015; 130: 234-241https://doi.org/10.1016/j.socscimed.2015.02.028
        • Carter KN.
        • Blakely T
        • Collings S
        • et al.
        What is the association between wealth and mental health?.
        J Epidemiol Community Health. 2009; 63: 221-226https://doi.org/10.1136/jech.2008.079483
        • Demakakos P
        • Biddulph JP
        • Bobak M
        • et al.
        Wealth and mortality at older ages: a prospective cohort study.
        J Epidemiol Community Health. 2016; 70: 346-353https://doi.org/10.1136/jech-2015-206173
        • Keese M
        • Schmitz H
        Broke, ill, and obese: is there an effect of household debt on health?.
        Rev Income Wealth. 2014; 60: 525-541https://doi.org/10.1111/roiw.12002
        • Drentea P
        • Lavraka PJ
        Over the limit: the association among health, race and debt.
        Soc Sci Med. 2000; 50: 517-529https://doi.org/10.1016/S0277-9536(99)00298-1
        • Ramsey SF
        • Bansal A
        • Fedorenko CR
        • et al.
        Financial insolvency as a risk factor for early mortality among patients with cancer.
        J Clinic Oncol. 2016; 34: 980-986https://doi.org/10.1200/JCO.2015.64.6620
        • Dean LT
        • Schmitz KH
        • Frick KD
        • et al.
        Consumer credit as a novel marker for economic burden and health after cancer in a diverse population of breast cancer survivors in the USA.
        J Cancer Survivorship. 2018; 12: 306-315https://doi.org/10.1007/s11764-017-0669-
        • Israel S
        • Caspi A
        • Belsky DW
        • et al.
        Credit scores, cardiovascular disease risk, and human capital.
        Proc Natl Acad Sci. 2014; 111: 17087-17092https://doi.org/10.1073/pnas.1409794111
        • Huang J
        • Sherraden M
        • Kim Y
        • et al.
        Effects of child development accounts on early social-emotional development: an experimental test.
        JAMA Pediatr. 2014; 168: 265-271https://doi.org/10.1177/0042085916682573
        • Huang J
        • Sherraden M
        • Purnell JQ
        Impacts of child development accounts on maternal depressive symptoms: evidence from a randomized statewide policy experiment.
        Soc Sci Med. 2014; 112 (https://doi.org/10.1016/j.socscimed.2014.04.023): 30-38
        • Collins MJ
        Financial Coaching: An Asset Building Strategy.
        Asset Funders Network Brief, 2013
        • Theodos B
        • Simms M
        • Treskon M
        • et al.
        An Evaluation of the Impacts and Implementation Approaches of Financial Coaching Programs.
        Urban Institute, 2015
        • NeighborWorks America
        Financial coaching: a proven approach for building consumer financial capability: a learning series from the Financial Capability Demonstration Project.
        2014
        • Rankin S
        Building sustainable communities: integrated services and improved financial outcomes for low-income households.
        Local Initiatives Support Corporation Brief, 2015
        • White ND
        • Packard KA
        • Flecky KA
        • et al.
        Two year sustainability of the effect of a financial education program on the health and wellbeing of single, low-income women.
        J Financ Counsel Plan. 2018; 29https://doi.org/10.1891/1052-3073.29.1.68
        • Reyes B
        • Lopez E
        • Phillips S
        • et al.
        Building Credit for the Underbanked: Social Lending as a Tool for Credit Improvement.
        Cesar E. Chavez Institute, San Francisco2013
        http://cci.sfsu.edu/maf
        Date accessed: August 6, 2017
        • O'Neill B
        • Sorhaindo B
        • Xiao JJ
        • et al.
        Financially distressed consumers: their financial practices, financial well-being, and health.
        J Financ Counsel Plan. 2005; 16: 73-87
        • Kim J
        • Garman ET
        • Sorhaindo B
        Relationships among credit counseling clients' financial wellbeing, financial behaviors, financial stressor events, and health.
        J Financ Counsel Plan. 2003; 14: 75-87
      2. Hoynes HW, Patel AJ. Effective Policy for Reducing Inequality? The Earned Income Tax Credit and the Distribution of Income. National Bureau of Economic Research. Working Paper 21340. Published July 2015.http://www.nber.org/papers/w21340.pdf. Accessed July 4, 2017.

        • Marr C
        • Huang C-C
        • Sherman A
        • et al.
        EITC and Child Tax Credit Promote Work, Reduce Poverty, and Support Children's Development, Research Finds.
        Center on Budget and Policy Priorities Website, 2015
        • Nichols A
        • Rothstein J
        The earned income tax credit (EITC).
        in: National Bureau of Economic Research Working Paper No. w21211. May 2015
        https://www.nber.org/papers/w21211.pdf
        Date accessed: June 30, 2017
        • Rehkopf DH
        • Strully KW
        • Dow WH
        The short-term impacts of earned income tax credit disbursement on health.
        Int J Epidemiol. 2014; 43: 1884-1894https://doi.org/10.1093/ije/dyu172
        • Evans WN
        • Garthwaite CL
        Giving mom a break: the impact of higher EITC payments on Maternal Health.
        Am Econ J Econ Pol. 2014; 6: 258-290https://doi.org/10.1257/pol.6.2.258
        • Averett S
        • Yang W
        The effects of earned income tax credit payment expansion on maternal smoking.
        Health Econ. 2013; 22: 1344-1359https://doi.org/10.1002/hec.2886
        • Hoynes HW
        • Miller DL
        • Simon D
        Income, the earned incomes tax credit, and infant health.
        Am Econ J Econ Policy. 2015; 7: 172-211
        • Klevens J
        • Schmidt B
        • Luo F
        • et al.
        Effect of the earned income tax credit on hospital admissions for pediatric abusive head trauma, 1995-2013.
        Public Health Rep. 2017; 132: 505-511https://doi.org/10.1177/0033354917710905
        • Strully KW
        • Rehkopf DH
        • Xuan Z
        Effects of prenatal poverty on infant health: state earned income tax credits and birth weight.
        Am Sociol Rev. 2010; 75: 534-562https://doi.org/10.1177/0003122410374086
        • Maxfield M
        The effects of the earned income tax credit on child achievement and long-term educational attainment.
        Michigan State University Job Market Paper, November 14, 2013
        • Michelmore K
        The effect of income on educational attainment: evidence from state earned income tax credit expansions.
        SSRN. 2014; https://doi.org/10.2139/ssrn.2356444
        • Mason LR
        • Nam Y
        • Clancy M
        • et al.
        Child development accounts and savings for children's future: do financial incentives matter?.
        Child Youth Serv Rev. 2010; 32: 1570-1576https://doi.org/10.1002/pam.21652
        • Marks E
        • Engelhardt G
        • Rhodes B
        • et al.
        SEED for Oklahoma kids: The Impact Evaluation.
        RTI International, Research Triangle Park, NC2014
        • Shanks T
        The promise of child development accounts: current evidence and future directions.
        Commun Invest. 2014; 2: 12-15
        • Kim Y
        • Huang J
        • Sherraden M
        • et al.
        Child development accounts, parental savings, and parental education expectations: a path model.
        Child Youth Serv Rev. 2017; 79: 20-28https://doi.org/10.1016/j.childyouth.2017.05.021
        • Jaganath D
        • Johnson K
        • Tschudy MM
        • et al.
        Desirability of clinic-based financial services in urban pediatric primary care.
        J Pediatr. 2018; 202: 285-290https://doi.org/10.1016/j.jpeds.2018.05.055
        • Quinn C
        • Johnson K
        • Raney C
        • et al.
        “In the clinic they know us”: preferences for clinic-based financial and employment services in urban pediatric primary care.
        Acad Pediatr. 2018; 18: 912-919https://doi.org/10.1016/j.acap.2018.06.008
        • Marcil LE
        • Hole MK
        • Wenren LM
        • et al.
        Free tax services in pediatric clinics.
        Pediatrics. 2018; 141e20173608https://doi.org/10.1542/peds.2017-3608
        • Garg A
        • Boynton-Jarrett R
        • Dworkin PH
        Avoiding the unintended consequences of screening for social determinants of health.
        JAMA. 2016; 316: 813-814