Do Investments in the Social Determinants of Health Reduce Health Care Costs?

Miller G,  Beaudin-Seiler B, Franco N.
Do Investments in the Social Determinants of Health Reduce Health Care Costs?
April 2021

Purpose:

This paper summarizes a review of studies that evaluated the impacts of social determinants of health (SDOH) interventions, with an emphasis on the costs of those innovations compared to the benefits received by patients. SDOH have a major effect on population health – 60% of premature deaths in the United States can be attributed to non-medical factors such as social circumstances and economic conditions. Thus, it’s important to understand where spending on SDOH can have the most impact on improving health outcomes. 

Research Methods:

The authors reviewed 237 studies that assessed SDOH interventions. They focused on four areas most likely to have an impact on health care costs – housing, nutrition, transportation and case management. They also evaluated the quality of the studies and grouped them by high, medium and low quality. The authors addressed four main questions when analyzing the studies:

• What is the potential for SDOH interventions to reduce the growth in health care spending?
• What is the potential for SDOH interventions to improve the health of the nation?
• To what extent is the cost for such interventions offset by their health care and non-health care financial impacts?
• What characteristics of such interventions are associated with their potential impacts?

Results:

The authors’ analysis showed that the evidence in the studies focused on a program’s impact on quality of life and social risk factors and they recommended that future studies should:

• Provide a deeper focus on mental and physical health outcomes, as well as health care spending.
• Document and present the evidence more thoroughly and contain more evidence from randomized controlled trials.
• Include more information about the economic impact of the interventions as well as their costs. 

Most of the studies within the categories of housing, transportation, nutrition and case management did not provide enough evidence of positive financial returns from the interventions. However, several studies did show positive returns in these areas, suggesting that interventions within some of the categories have potential to reduce health spending.

Successful interventions had these characteristics in common:

• Housing: interventions that tended to be targeted to populations most in need, used care coordinators and had an education component.
• Nutrition: interventions where meals were medically tailored to patient needs, included opportunities to socialize, and involved partnerships between community organizations and hospitals.
• Transportation: interventions that targeted the populations they served to low-income patients with specific medical conditions, such as diabetes or hypertension, and involved community-hospital partnerships. 
• Case management: interventions that addressed multiple types of social support, focused on a clear outcome, such as 30-day readmissions or utilization of skilled nursing facilities and involved community-hospital partnerships.

Conclusion:

There were only a handful of studies that provided enough evidence to determine whether there was a connection between the intervention and the return on investment. Researchers noted that most studies did not allow for the assessment of the financial impact of an intervention. 

Going forward, the authors recommended improving the quality of the study design through formal guidelines for conducting and evaluating SDOH studies. Guidelines for SDOH evaluations could include focusing on the areas of design, sample size and outcomes reported.

Importantly, the authors note that “the limited quality and consistency of the existing body of evidence of the costs and benefits of SDOH interventions constrains our ability to design and implement efficient and effective programs. While some housing, meal delivery, and case management interventions show promise for improving health and helping to control health care costs, further high-quality research is needed to ensure that future investments in these and other SDOH represent dollars well spent.”