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Aligning social services and medical services

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Now that the Supreme Court has, at least for a while, ended the  long uncertainty about the Affordable Care Act, many healthcare policy experts think that a big push is needed to better align the healthcare system and social-service providers in order to improve population health.

As Elizabeth Bradley and Lauren Taylor write in HealthAffairs:

“Unequivocal literature reveals that the vast majority of premature mortality and morbidity is attributable to social, behavioral,  and environmental factors. Nevertheless, the U.S.  expenditure on healthcare, largely targeting the medical determinants of health, comprises 18 percent of the gross domestic product (GDP) while investments in key social determinants of health such as housing, income support, education, and nutritional support is dwarfed in comparison, consuming less than 10 percent of GDP. Some have argued that federal, state, and local tax structures compensate for this relative limited spending in social welfare; however, the major beneficiaries of tax subsidies are middle-income, rather than low-income families and individuals for whom the negative social determinants of health are most pressing.”

“The spending of our international peers in Western Europe …reflects a very different pattern than that of the US, as the ratio between spending on social services and healthcare is 2:1 in many peer countries compared to the ratio 1:1 in the U.S. If spending on social services is interpreted a proxy for attention paid to the social determinants of health, the U.S. is lagging….”

“{G}reater evidence about the impact of social-service investments and of partnerships between healthcare and social service providers on health and healthcare costs may stimulate adoption of a new mental model in which health is created by a variety of interventions apart from healthcare. In fact, our review of the literature funded by the Blue Cross Blue Shield of Massachusetts Foundation, boasts several rigorous and longitudinal studies that produce credible findings about just that — investments in specific types of social services and partnerships with healthcare providers can result in improved health outcomes and have been cost neutral or cost saving.”





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