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. 2021 Dec;24(6):710-721.
doi: 10.1089/pop.2021.0043. Epub 2021 May 14.

A Scoping Review of Behavioral Interventions Addressing Medical Financial Hardship

Minal R Patel  1   2 , Reshma Jagsi  2   3   4 , Kenneth Resnicow  1   2 , Shawna N Smith  5 , Lauren M Hamel  6 , Christopher Su  2   7 , Jennifer J Griggs  2   5   7   8 , Diamond Buchanan  1 , Nicole Isaacson  1 , Michelle Torby  1
Affiliations

A Scoping Review of Behavioral Interventions Addressing Medical Financial Hardship

Minal R Patel et al. Popul Health Manag. 2021 Dec.

Abstract

Little information has been compiled across studies about existing interventions to mitigate issues of medical financial hardship, despite growing interest in health care delivery. The purpose of this qualitative systematic scoping review was to examine content and outcomes of interventions to address medical financial hardship. PRISMA guidelines were applied to present results using PubMed, Scopus, and CINAHL, published between January 1980 and August 2020. Additional studies were identified through reference lists of selected papers. Included studies focused on mitigating medical financial hardship from out-of-pocket (OOP) health care expenses as an intervention strategy with at least 1 evaluation component. Screening 2412 articles identified 339 articles for full-text review, 12 of which met inclusion criteria. Variation was found regarding targets and outcome measurement of intervention. Primary outcomes were in the following categories: financial outcomes (eg, OOP expenses), behavioral outcomes, psychosocial, health care utilization, and health status. No included studies reported significant reduction in OOP expenses, perceptions of financial burden/toxicity, or health status. However, changes were observed for behavioral outcomes (adherence to treatment, patient needs addressed), some psychosocial outcomes (mental health symptoms, perceived support, patient satisfaction), and care utilization such as routine health care. No patterns were observed in the achievement of outcomes across studies based on intensity of intervention. Few rigorous studies exist in this emerging field, and studies have not shown consistent positive effects. Future research should focus on conceptual clarity of the intervention, align outcome measurement and achieve consensus around outcomes, and employ rigorous study designs, measurement, and outcome follow-up.

Keywords: financial toxicity; health care; interventions; medical financial hardship.

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Conflict of interest statement

Dr. Jagsi has no relevant conflicts. Outside the submitted work, Dr. Jagsi has stock options as compensation for her advisory board role in Equity Quotient, a company that evaluates culture in health care companies; she has received personal fees from Amgen and Vizient and grants for unrelated work from the National Institutes of Health, the Doris Duke Foundation, the Greenwall Foundation, the Komen Foundation, and Blue Cross Blue Shield of Michigan for the Michigan Radiation Oncology Quality Consortium. She has a contract with Genentech to investigate financial toxicity experiences of breast cancer patients. She has served as an expert witness for Sherinian and Hasso and Dressman Benzinger LaVelle. She is an uncompensated founding member of TIME'S UP Healthcare and a member of the Board of Directors of ASCO.

The coauthors declare that there are no conflicts of interest.

Figures

FIG. 1.
FIG. 1.
PRISMA flow diagram. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
See this image and copyright information in PMC

References

    1. Starr P. Transformation of defeat: the changing objectives of national health insurance, 1915–1980. Am J Public Health 1982;72:78–88. - PMC - PubMed
    1. Obama B. United States health care reform: progress to date and next steps. JAMA 2016;316:525–532. - PMC - PubMed
    1. Cohen RA, Kirzinger WK. Financial burden of medical care: a family perspective. NCHS Data Brief 2014;142:1–8. - PubMed
    1. Mathes T, Jaschinski T, Pieper D. Adherence influencing factors—a systematic review of systematic reviews. Arch Public Health 2014;72:37.. eCollection 2014. - PMC - PubMed
    1. McHorney CA, Spain CV. Frequency of and reasons for medication non-fulfillment and non-persistence among American adults with chronic disease in 2008. Health Expect 2011;14:307–320. - PMC - PubMed

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