Integrating Social and Medical Care: Could it Worsen Health and Increase Inequity?

Gottlieb LM, Alderwick H
Source: Annals of Family Medicine
Publication Year: 2019
Population Focus: Medicaid beneficiaries
Demographic Group: Adult
Type of Literature: White
link: http://www.annfammed.org/content/17/1/77.full.pdf+html
Abstract

As a result of a large and compelling body of evidence documenting the impacts of social determinants, such as income and education, on health outcomes, healthcare systems are beginning to incorporate social and economic risk data into healthcare delivery decisions. But there is a risk that some of these efforts could worsen health and widen health inequities. We highlight 3 examples— including recent policy changes in Medicaid, social needs, informed risk prediction models, and advances in precision medicine—where the inclusion of social risk information threatens to reduce care quality or healthcare access for some groups of patients. A new dialog is needed about both the opportunities and potential consequences of bringing information about patients’ social circumstances into a market-based healthcare system.

Insights Results

Overview of article

  • healthcare systems are beginning to incorporate social and economic risk data into healthcare delivery decisions. But there is a risk that some of these efforts could worsen health and widen health inequities. This article highlights 3 examples— including recent policy changes in Medicaid, social needs, informed risk prediction models, and advances in precision medicine—where the inclusion of social risk information threatens to reduce care quality or healthcare access for some groups of patients

Results

  • Work requirements as conditions for Medicaid eligibility are likely to have a small effect on job-seeking behaviors and are more likely to reduce access to healthcare services by adding substantial disincentives to enrollment
  • Risk prediction modeling based on certain patient characteristics could results in bias based on social data and inequitable de-escalation of care for specific groups of patients
  • Advances in precision medicine could lead to easier fixes for the problem at hand. One threat of introducing social biomarkers is sacrificing a discussion about how health inequity is part of a larger frame of social inequity

Key takeaways/implications

  • Though the historic push for SDOH-related interventions in healthcare settings has been closely connected to an interest in improving health and decreasing health inequities, a more critical lens now needs to be applied when examining how current activities affect health and equity
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