The notion of hospitals addressing "social determinants" of patients during care episodes is much in the news. A recent article described this approach as a key element in "complete care" (see: Complete care: Hospitals tackling social determinants set the course). Below is an excerpt from the article:
[Health] [s]ystems adopting...unconventional approaches to managing chronic disease are becoming less unusual as the concept of addressing social determinants of health sweeps the industry. Income, education, employment, food security, housing stability and violence are all targeted factors to help improve patient health.
What are social determinants of health?
* Housing instability
* Food insecurity
* Transit
* Education
* Utility needs
* Violence
* Family and social support
* Employment and income
I certainly agree that social determinants are critical in determining the success of healthcare services for many patients and I am pleased that some health systems are addressing this problem in a coordinated and effective way. My quibble about this is whether such an effort should be one of their prime missions. I would argue against this idea and suggest that hospitals should place their prime emphasis on the reduction of the cost of healthcare while at the same time make referrals to local, state, and federal agencies whose primary mission is addressing social determinants. Here's a short paragraph about the cost of healthcare in the U.S that is completely out of control and requires much more attention on the part of health system executives (see: Health care in the United States):
In 2013 the U.S. spent 17.1% of its total GDP on healthcare, 50% more than the second highest spending country, France (11.6%). In 2014, the U.S. spent $2.6 trillion (a 5.0% increase from 2013) on personal health care expenditures. In 2015 the U.S. spent $3.2 trillion which is about 17.8%. Per capita spending was $8,054 in 2014—up from $7,727 in 2013. In 2011, the U.S. paid nearly twice as much as Canada yet lagged behind other wealthy nations in such measures as infant mortality and life expectancy.
I think that I will be waiting a long time to hear the CEO of any health system suggest that their prime mission is reducing the cost of care while maintaining quality. One reason is probably that most patients are insured and don't pick providers on the basis of cost. Moreover, hospital pricing is so opaque that it's difficult to determine the cost of any care episodes a priori. This is a problem that also needs a remedy.
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