The Economics of Social Prescribing: What Do We Know About Costs, Cost-Effectiveness and Sustainable Funding?

The Economics of Social Prescribing: What Do We Know About Costs, Cost-Effectiveness and Sustainable Funding?

Social prescribing is often described in economic terms. It may reduce pressure on healthcare, prevent avoidable service use, generate wider social value or even save money. Some individual programs have reported findings consistent with these claims, but moving from a promising local evaluation to the conclusion that social prescribing as a whole saves money or is cost-effective is a much bigger step.

The economic question is also more complicated than asking whether a link worker costs less than a medical appointment. Social prescribing depends on a pathway. Someone identifies a need, time is spent exploring what matters to the person, a suitable resource has to exist, the person may need support to reach it, and a community organization needs enough capacity to receive them. Coordination, supervision, information systems, evaluation, staff, facilities, volunteer support and sometimes transport or participation costs all sit somewhere within that pathway.

Who pays those costs matters. So does who receives the benefits.

The first international systematic review specifically examining the health economics of social prescribing was published in January 2026. Despite the rapid growth of social prescribing internationally, it identified only 18 eligible studies, including five randomized controlled trials, one quasi-experimental study and 12 mixed-methods studies. Standard economic evaluation methods were used inconsistently, and the authors concluded that robust economic evidence remains limited for healthcare planning, commissioning and sustainable funding decisions.[1]

This does not mean social prescribing has no economic value. It means that we currently know less about that value than confident claims about savings or return on investment sometimes suggest.

For Viet Nam, that distinction is especially important. Social prescribing remains at an early stage, and economic evidence generated in other health systems cannot simply be transferred into a Vietnamese financing model.

Key Points

Economic evaluation should ask more than whether healthcare use falls. It should identify the full costs of the pathway, what outcomes are produced, who bears the costs and who receives the benefits. Cost-saving is not the same as cost-effective. Cost-effective does not necessarily mean affordable. A positive Social Return on Investment is different again.

The 2026 international systematic review found encouraging economic results in some programs, but the evidence was heterogeneous, geographically concentrated and based on methods that were often difficult to compare.[1] Sustainable funding also requires attention to the organizations providing community activities, not only link workers or referring healthcare services.

For Viet Nam, early pilots should collect economic data prospectively and test financing arrangements rather than assume that social health insurance, hospitals, local authorities or community organizations should fund social prescribing through any particular mechanism.

What does social prescribing really cost?

At first glance, the direct costs may appear relatively simple. A program might require a referral mechanism, a link worker or another linking function, training and some administrative support. In practice, the cost base is considerably wider.

A linking role requires staff time, and those staff may need supervision and continuing training. Someone needs to identify, verify and update information about community resources. Partnerships require time for communication. Digital systems can involve development, licensing, maintenance and data-governance costs. Evaluation requires data collection and analysis.

Then there is the community side of the pathway. A walking group requires organization. An arts program needs space and materials. A community organization may need additional staff or volunteer coordination when referral numbers rise. Some resources may need accessibility adaptations, additional equipment or more structured support for participants. The 2026 systematic review showed that existing evaluations variously included staff time, volunteer expenses, venue hire and materials, illustrating how differently “program cost” has been defined across studies.[1]

Participants can also bear costs. These may include transport, participation fees, digital access, time away from work or caregiving responsibilities. A pathway that appears inexpensive from the healthcare system's perspective may still be expensive for the person expected to participate.

This is why every economic evaluation needs a clearly stated perspective. A healthcare-payer perspective may focus largely on program costs and changes in healthcare utilization. A wider societal perspective may include participant expenses, productivity, caregiver impacts, volunteer contributions and broader social outcomes. Neither perspective is automatically appropriate for every decision, but the reader needs to know whose costs and benefits have been counted.

A program should not appear economically attractive merely because costs have been moved somewhere the evaluation did not look.

The same principle applies when existing staff or infrastructure are used. If a nurse, social worker or community employee spends time on social prescribing, that time is not automatically free simply because no new position has been created. Resources used for one activity cannot simultaneously be used elsewhere. In economic terms, this is an opportunity cost, and it should be considered even when it does not appear as a new line in the organization's budget.

Cost-saving, cost-effectiveness and affordability are different questions

Economic terminology is easily misunderstood.

A program is cost-saving when it costs less without producing worse outcomes, or when it both costs less and produces better outcomes, within the perspective and time horizon being analyzed.

Cost-effectiveness asks a different question. A program may cost more and still offer reasonable value if the additional outcomes justify the additional cost compared with a realistic alternative. Depending on the intervention, cost-effectiveness analysis may examine the cost of achieving an additional unit of physical activity, improving another relevant outcome or preventing an adverse event.

Cost-utility analysis commonly expresses health benefits in quality-adjusted life years, or QALYs, which allows interventions with different health effects to be compared using a common outcome. Cost-benefit analysis, by contrast, attempts to express both costs and benefits in monetary terms.

A program can therefore be cost-effective without being cost-saving.

It can also be cost-effective without being affordable. An intervention may offer reasonable value for each additional unit of benefit while still requiring a total budget that a health system, local authority or community sector cannot realistically sustain when implemented at scale. Cost-effectiveness and budget impact should therefore be considered separately when a program moves beyond a small pilot.

The 2026 systematic review provides a useful example. A chair-based yoga intervention for older adults with multimorbidity cost approximately £81 more per participant and generated a small additional QALY gain. The analysis estimated a 79% probability of cost-effectiveness at a willingness-to-pay threshold of £20,000 per QALY, even though the trial did not demonstrate statistically significant improvements in health-related quality of life, mental health or loneliness.[1]

That finding does not prove that chair-based yoga, or social prescribing more generally, is cost-effective. It illustrates how economic conclusions depend on the comparator, outcome, model assumptions and decision threshold being used.

The £20,000 per QALY threshold belongs to the decision context used in that UK analysis. It should not be transferred to Viet Nam as though the two health systems shared the same willingness-to-pay threshold or budget constraints.

The same caution applies to healthcare utilization. A reduction in primary-care appointments or hospital visits does not automatically translate into a cash saving. Many healthcare costs are fixed in the short term. Fewer appointments may release capacity for other patients without reducing total expenditure by the monetary value assigned to those visits.

Released capacity can still be valuable. It simply should not be described as money saved unless the analysis demonstrates an actual reduction in expenditure.

What does the current economic evidence show?

The January 2026 systematic review remains the clearest international synthesis of economic evidence.

Its 18 studies examined several types of intervention, including exercise and loneliness-prevention programs, coaching, nature-based interventions and dance or movement programs. Economic methods included cost-effectiveness, cost-utility, cost-consequence, cost-benefit and Social Return on Investment analyses.[1]

Some findings were encouraging. Particular trial-based interventions appeared cost-effective under the assumptions and thresholds used, and several Social Return on Investment studies reported positive social value.

However, the evidence base was small and geographically concentrated. Nine of the 18 studies were from the United Kingdom, and relatively little economic evidence came from other health systems.[1] The interventions, populations, outcomes, costing methods, perspectives and time horizons also differed substantially.

The systematic review therefore reached a cautious overall conclusion: despite positive findings from some individual programs, there are too few rigorous and comparable economic evaluations to draw firm conclusions about the overall costs or value for money of social prescribing.[1]

That conclusion is more useful for policy than selecting the most favorable result reported by an individual program.

Social Return on Investment can show wider value, but it is not a financial return

Many potential benefits of social prescribing sit outside traditional clinical outcomes.

A participant may become less lonely, return to employment or regain confidence. A caregiver may experience less strain. A volunteer may develop skills or purpose. A community organization may strengthen local relationships. Conventional healthcare measures may not capture all of these effects.

Social Return on Investment, or SROI, attempts to place a monetary value on broader social, economic and sometimes environmental changes.

That can be useful in social prescribing because its intended effects often extend beyond healthcare. But SROI is not the same as conventional cost-effectiveness analysis, and an SROI ratio is not an accounting return received by the organization that financed the program.

The estimate depends on which outcomes are included, what monetary proxies are assigned to those outcomes, how much change is attributed to the intervention, how much would have happened anyway, how long benefits are assumed to last and what other adjustments are made.

Ten of the 18 studies in the 2026 systematic review used SROI. The review summarized their findings as generally favorable, with estimated social value reaching as high as approximately £7.08 for every £1 invested, but there was considerable variation between programs and study-level assumptions.[1] These figures should therefore be interpreted as modeled estimates of social value within specific evaluations, not as a universal financial return for social prescribing.

It would be misleading to summarize the literature simply as:

“Social prescribing returns up to £7 for every £1 spent.”

The economic review did not establish such a general rule.

SROI may therefore complement conventional health-economic analysis, particularly where wider social outcomes matter, but the two methods answer different questions.

Who pays, who benefits and who carries the cost?

Social prescribing crosses sectors, creating an economic challenge that is easy to overlook. The organization making the investment may not be the organization in whose budget the measurable benefit appears.

A health service might pay for the linking function while community organizations absorb additional participants. A local authority might invest in community infrastructure while healthcare potentially benefits from improved well-being or reduced demand. A nonprofit organization may deliver activities using grants and volunteers while participants, employers or healthcare services receive part of the value.

This is sometimes described as a cross-sector budget-silo, or “wrong-pocket,” problem. If one sector must invest while another receives much of the measurable benefit, asking each organization to finance only activities that create returns within its own budget can lead to underinvestment in the overall pathway.

The reverse problem is equally possible. Healthcare may finance referral infrastructure and link workers while the organizations expected to receive participants remain under-resourced.

A global scoping review published in 2026 identified short-term and siloed funding, unstable commissioning, workforce pressures, volunteer shortages and limited community-sector capacity as recurring barriers to social prescribing. It specifically warned that commissioning link-worker capacity without also considering the capacity of organizations receiving referrals risks weakening the pathway.[2]

Economics therefore cannot stop at the referral point. The financial sustainability of the receiving side matters as much as the sustainability of the linking function.

A September 2026 case study of nature-based social prescribing in Lancashire and South Cumbria illustrates this issue from the perspective of community organizations. The authors found that sustainable funding and resourcing remained difficult and explored a proposed “infinity model” intended to illustrate relationships between stakeholders and resource flows.[4] This is a single UK case study and should not be generalized to all social prescribing systems, but it reinforces the point that community delivery cannot be separated from pathway financing.

Sustainable funding and equity need to be considered together

A program can appear successful during a grant-funded pilot and still be financially fragile.

Short-term funding may support link workers and community services for one or two years. Referral volume grows, relationships form and participants begin relying on the pathway. When funding ends, staff disappear or community organizations reduce their activities. The 2026 global review found unstable funding and constrained voluntary-sector capacity repeatedly affected continuity and sustainability.[2]

A sustainable financing model therefore needs to consider the linking workforce, coordination, supervision, information systems, evaluation, community-provider capacity, accessibility and the actual activities to which people are connected.

Sustainability does not necessarily mean one permanent funding source. Different settings may combine public budgets, healthcare resources, local-government funding, grants, contracts, philanthropic support or other mechanisms. The important question is whether the pathway can operate without depending indefinitely on hidden subsidies from unpaid labour, short-term grants or community organizations absorbing increasing demand without resources.

Economic efficiency should also not be separated from equity.

A program may appear cheaper if it depends heavily on digital referral, expects participants to arrange their own transport or refers people only to activities that charge fees. These design choices can shift costs to participants and exclude people with fewer resources.

Concentrating programs in high-volume urban areas may lower average cost per participant while leaving rural or underserved communities with limited access.

The global 2026 evidence identifies poverty, transport problems, digital exclusion and uneven distribution of community resources as important barriers to participation.[2]

Economic evaluation should therefore ask not only:

“How much does the pathway cost per person?”

but also:

“Who can realistically access it at that cost?”

Transport support, interpretation, accessible venues, outreach, digital assistance or additional staff time may increase program expenditure while improving equity. These costs should be visible rather than classified automatically as inefficiency.

What does this mean for Viet Nam?

Current economic evidence provides very little basis for importing a financing model directly into Viet Nam.

The international systematic review contained no economic evidence base specific to Viet Nam and was strongly influenced by UK and European studies.[1] The 2026 Western Pacific review identified 42 peer-reviewed studies and 13 grey-literature sources across the region, but only one peer-reviewed study came from Viet Nam, and models varied considerably in structure, funding and population reach.[3]

Viet Nam's health system, social health insurance arrangements, grassroots health infrastructure, local authorities, community organizations and patterns of family and informal support differ significantly from the settings that generated most existing economic evidence.

WHO describes health financing as a core health-system function concerned with mobilizing, pooling and using funds to meet population health needs, with financing arrangements directly influencing availability, accessibility and affordability.[6] In Viet Nam, WHO's current health-system strengthening priorities include mobilizing resources adequately and equitably, strengthening grassroots and commune-level services and improving primary care as part of progress toward universal health coverage.[7]

Social prescribing should therefore not begin with an assumption that social health insurance should pay for it, hospitals should fund it, or community organizations can provide it for free.

These are financing options to investigate, not conclusions supported by current Vietnamese evidence.

An early Vietnamese model should first identify which resources already exist and which elements genuinely create additional costs. Some functions may build on existing healthcare, social-work or community infrastructure, but using existing staff does not make those resources free. Staff time diverted from other duties carries an opportunity cost even when no new budget line is created.

Community organizations may already provide valuable activities, but greater referral demand can create additional staffing, space, material, accessibility and coordination costs.

The financing question is therefore broader than “Who should pay for social prescribing?”

A better question is:

“What resources are required, which existing resources are being used, where do the benefits accrue, what alternatives are we giving up, and what financing arrangement can sustain the pathway without shifting unreasonable costs onto participants or community organizations?”

How should a Vietnamese pilot evaluate economic value?

Economic evaluation should be designed before implementation rather than added at the end of a pilot.

If staff time, community-provider costs, participant expenses or changes in service use are not recorded prospectively, reconstructing them later can be difficult and unreliable.

A Vietnamese pilot should therefore define its economic questions at the outset.

Direct pathway costs may include staff time for referral and linking, training, supervision, administration, technology, coordination and evaluation. Community-provider costs may include staff or volunteer coordination, facilities, materials and additional capacity generated by referrals. Participant costs can include transport, participation fees, time and digital access.

Healthcare and social-service utilization may also be relevant depending on the program's theory of change, but reduced utilization should not automatically be converted into monetary “savings.” Evaluation should distinguish between lower service activity, released capacity and actual reductions in expenditure.

The comparator also matters. Economic value cannot be determined in isolation. The relevant question is what happens compared with usual care, another community intervention, another referral pathway or another realistic use of the same resources.

Outcomes should match the purpose of the program. These might include health-related quality of life, well-being, social connection, physical activity, participation or other relevant outcomes. Conventional cost-effectiveness or cost-utility analysis may be appropriate for some questions, while cost-consequence or SROI approaches may provide additional information about wider social outcomes.

The time horizon should be long enough to capture relevant costs and benefits but not so long that projections become dominated by unsupported assumptions. Existing social prescribing economic studies have used widely varying time horizons, including long-term models extending several years.[1]

Where modeling is used, assumptions should be explicit and uncertainty should be tested through sensitivity analysis.

A pilot intended for possible scale-up should also consider budget impact. Even an intervention judged cost-effective may require a total level of expenditure that cannot be accommodated within available budgets. Decision-makers therefore need to understand both value for money and affordability.

Most importantly, the analysis should state clearly whose perspective it adopts. The same pathway can look economically attractive from one organization's budget and burdensome from another's.

Stronger evidence therefore connects three elements: cost, outcome and implementation.

Knowing that a program costs a certain amount tells us little without knowing what it changed. Knowing that participants improved does not show whether the same outcome could have been achieved more efficiently elsewhere. Lower healthcare use does not prove causation or cash savings. A positive SROI ratio does not establish that a health payer should reimburse the intervention.

The January 2026 systematic review concluded that economic evaluation in social prescribing remains an emerging and underdeveloped field and called for more standardized, longer-term and geographically diverse research.[1]

For Viet Nam, that evidence gap is also an opportunity. A carefully designed pilot that incorporates health economics from the beginning could produce locally useful evidence and contribute to the international evidence base rather than simply importing assumptions developed elsewhere.

Key Takeaway

Social prescribing may create economic value, but current evidence is not strong enough to treat cost savings as an established benefit.

The best international systematic review available in 2026 identified only 18 eligible economic studies. Some individual programs produced favorable cost-effectiveness findings or positive estimates of social value, but interventions, study designs, perspectives, outcomes and assumptions varied substantially, and conventional economic evidence remains limited.[1]

Four distinctions are therefore essential:

Lower healthcare use is not automatically a financial saving. Cost-effective does not mean cost-saving. Cost-effective does not necessarily mean affordable. And a positive Social Return on Investment does not prove that a program is cost-effective to a healthcare payer.

Sustainable financing also needs to support the whole pathway. Funding referral and linking capacity without ensuring that community organizations have adequate resources may simply shift pressure from one part of the system to another.

For Viet Nam, it would be premature to prescribe a national financing mechanism for social prescribing. A stronger starting point is to test small-scale models, measure their full resource requirements, compare them with realistic alternatives, understand where costs and benefits fall and examine whether the organizations expected to sustain the pathway can actually afford to do so.

The central economic question is therefore not simply:

“Does social prescribing save money?”

It is:

“What does the pathway really cost, what outcomes and wider value does it create, compared with what alternative, who pays, who benefits, and can that value be sustained without shifting hidden costs onto participants or communities?”

That is a harder question. It is also the question health systems need answered before social prescribing can be funded responsibly at scale.

References

1. Lynch M, Keating AJ, Morrow E, Spencer LH. The health economics of social prescribing: systematic review of the international evidence. Frontiers in Public Health. 2026;14:1753435. doi:10.3389/fpubh.2026.1753435.

2. Kisa A, Kisa S. Models, implementation, and reported outcomes of social prescribing interventions: a scoping review. Frontiers in Public Health. 2026;14:1871347. doi:10.3389/fpubh.2026.1871347.

3. Lwin KS, Wong MSJ, Tan MH, et al. Organization and implementation of social prescribing in the Western Pacific Region: a scoping review. The Lancet Regional Health - Western Pacific. 2026;67:101714. doi:10.1016/j.lanwpc.2025.101714.

4. Pywell S, Reynolds K, Kenyon A, et al. Sustainable models of funding and resourcing nature based social prescribing in Lancashire and South Cumbria: a case study. Journal of Integrated Care. Published online 18 September 2026. doi:10.1108/JICA-07-2025-0066.

5. World Health Organization Regional Office for the Western Pacific. A toolkit on how to implement social prescribing. Manila: World Health Organization Regional Office for the Western Pacific; 2022.

6. World Health Organization Viet Nam. Health financing in Viet Nam. WHO Viet Nam. Accessed 26 September 2026.

7. World Health Organization Viet Nam. Strategic Priority 1: Health system strengthening. WHO Viet Nam. Accessed 26 September 2026.

Article Information

Published: 26 September 2026
Last reviewed: 26 September 2026
Publisher: Social Prescribing Vietnam

Disclaimer

This article is provided for educational and informational purposes. It does not constitute health-economic advice, financial advice, reimbursement guidance, legal advice, commissioning guidance or official policy. Economic findings from social prescribing studies depend on the intervention, population, comparator, analytic perspective, costing assumptions, outcome measures, time horizon and health-system context. Results from other countries should not be assumed to apply directly to Viet Nam. Decisions about funding, reimbursement or resource allocation should be based on locally applicable evidence, policy, legal requirements, budget impact and formal economic evaluation where appropriate.