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US Medical-Legal Partnerships to Address Health-Harming Legal Needs: Closing the Health Injustice Gap

  • Narrative Review
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Abstract

The medical-legal partnership (MLP) model is emerging across the USA as a powerful tool to address the adverse social conditions underlying health injustice. MLPs embed legal experts into healthcare teams to address health-harming legal needs with civil legal remedies. We conducted a narrative review of peer-reviewed articles published between 2007 and 2022 to characterize the structure and impacts of US MLPs on patients, providers, and healthcare systems. We found that MLPs largely serve vulnerable patient populations by integrating legal experts into community-based clinical settings or children’s hospitals, although patient populations and settings varied widely. In most models, healthcare providers were trained to screen patients for legal needs and refer them to legal experts. MLPs provided a wide range of services, such as assistance accessing public benefits (e.g., Social Security, Medicaid, cash assistance) and legal representation for immigration and family law matters. Patients and their families also benefited from increased knowledge about legal rights and systems. Though the evidence base remains nascent, available studies show MLPs to be associated with greater access to care, fewer hospitalizations, and improved physical and mental health outcomes. Medical and legal providers who were engaged in MLPs reported interdisciplinary learning, and healthcare systems often experienced high returns on investment through cost savings and increased Medicaid reimbursement. Many MLPs also conducted advocacy and education to effect broader policy changes related to population health and social needs. To optimize the MLP model, more rigorous research, systematic implementation practices, evaluation metrics, and sustainable funding mechanisms are recommended. Broader integration of MLPs into healthcare systems could help address root causes of health inequity among historically marginalized populations in the USA.

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Data Availability

The dataset generated during the current study is available from the corresponding author on reasonable request.

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Acknowledgements:

Drs. Tung and Zakrison were supported by a DOJ/OJJDP grant (15PJDP-21-GK-03863-CBVP; PIs: Tung/Zakrison) in Comprehensive Youth Violence Prevention and an NIH/NICHD grant (UG3HD111325; PI: Zakrison) in Community Level Interventions for Firearm and Related Violence. Dr. Tung was supported by an NIH/NHLBI career development grant (1K23HL145090-01) in patient-oriented research. Dr. Zakrison is also a Robert Wood Johnson Foundation Interdisciplinary Research Leader with a grant on Structural Racism and Community Health and Well-Being.

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Authors and Affiliations

  1. Pritzker School of Medicine, University of Chicago, Chicago, IL, USA

    Daniel Y. Johnson BA, Spencer Asay BS, Grace Keegan BS, Lisa Wu BS, Maeson L. Zietowski BS & Nathan Muntz MD

  2. Section of Trauma & Acute Care Surgery, Department of Surgery, University of Chicago, Chicago, IL, USA

    Tanya L. Zakrison MD, MPH

  3. Department of Public Health Sciences, University of Chicago, Chicago, IL, USA

    Rhea Pillai MPH

  4. Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA

    Elizabeth L. Tung MD, MS

  5. Center for Health and The Social Sciences, University of Chicago, Chicago, IL, USA

    Elizabeth L. Tung MD, MS

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Contributions

ELT, TLZ, DYJ, SA, GK, LW and MLZ conceptualized the study. DYJ coordinated all review activities. DYJ, SA, GK, LW, and MLZ collaborated on study searching, screening, data extraction, and quality appraisal. All authors critically revised the article for important intellectual content and approved the final version. All authors had full access to the data in the study and had final responsibility for the decision to submit for publication.

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Correspondence to Elizabeth L. Tung MD, MS.

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Johnson, D.Y., Asay, S., Keegan, G. et al. US Medical-Legal Partnerships to Address Health-Harming Legal Needs: Closing the Health Injustice Gap. J GEN INTERN MED (2024). https://doi.org/10.1007/s11606-023-08546-0

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