UPMC Center for High-Value Health Care, Pittsburgh (Kinsky); Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh (Creasy, Hawk).
Psychiatr Serv. 2019 Aug 1;70(8):714-727. doi: 10.1176/appi.ps.201800320. Epub 2019 Apr 30.
The Social Security Administration's Representative Payment Program appoints payees as financial managers for individuals determined incapable of managing their funds. The aim is to afford stability and increase clients' ability to meet health and behavioral priorities. This systematic review examined literature on the effect of representative payee services on identified outcomes.
A search of academic databases and gray literature was conducted in November 2015 and repeated in December 2017. Included studies had a comparison group; excluded studies examined services other than representative payee. Primary outcomes included substance use, symptoms of mental illness, housing stability, quality of life, and other health-specific outcomes. Secondary outcomes included the client-payee relationship and client satisfaction with services.
Eighteen articles met inclusion criteria. Studies assessing primary outcomes found several positive and few negative effects of representative payee services. Studies examining secondary outcomes indicated that receipt of such services may affect the client-provider relationship, increase conflict and violence, and increase clients' perceptions of financial leverage (i.e., a payee's use of control over funds to encourage, incentivize, or otherwise coerce certain behaviors). Most studies were of poor or moderate quality. Studies spanned nearly two decades, and results may have been confounded by the evolution of service delivery modalities.
Representative payee services are largely beneficial or neutral in terms of health and behavior outcomes. Negative findings mainly involved the client-payee relationship. Given that more than five million individuals have a representative payee, assessing the impact of these services with more rigorous research designs is worthwhile.
美国社会保障署的代表付款计划指定付款人为无能力管理自己资金的个人的财务经理。目的是提供稳定性并提高客户满足健康和行为优先事项的能力。本系统评价研究了代表付款人服务对确定结果的影响的文献。
于 2015 年 11 月和 2017 年 12 月对学术数据库和灰色文献进行了检索。纳入的研究有对照组；排除了研究代表付款人以外的服务。主要结果包括物质使用、精神疾病症状、住房稳定性、生活质量和其他健康特定结果。次要结果包括客户-付款人关系和客户对服务的满意度。
有 18 篇文章符合纳入标准。评估主要结果的研究发现，代表付款人服务有一些积极的影响和一些负面的影响。考察次要结果的研究表明，接受此类服务可能会影响客户-提供者的关系，增加冲突和暴力，并增加客户对财务杠杆的看法（即付款人对资金的控制的使用，以鼓励、激励或以其他方式强迫某些行为）。大多数研究的质量较差或中等。研究跨越了近二十年，结果可能因服务提供模式的演变而受到影响。
代表付款人服务在健康和行为结果方面基本上是有益的或中性的。负面的发现主要涉及客户-付款人关系。鉴于有超过 500 万人有代表付款人，使用更严格的研究设计评估这些服务的影响是值得的。
