Letters: COVID-19 may be inflection point for investment in social determinants

The COVID-19 crisis underscores the importance of strategic, well-targeted programs to address social determinants of health.

Food insecurity has skyrocketed. Housing instability is likely to grow as unemployment persists and eviction moratoriums expire. Social distancing may exacerbate social isolation. These and other social determinants of health, or SDOH, are well-known to impair management of chronic conditions, like asthma and heart disease, and to increase unnecessary utilization of emergency rooms and inpatient care. As a result, a secondary effect of the coronavirus crisis may be preventable declines in health, particularly among lower-income populations.

At the same time, the capacity to provide social services is strained. Community-based organizations, primary-care practices and emergency rooms are on the front lines of identifying people facing health-related social needs and referring them to or providing services. They face revenue shortfalls, staff shortages and massive uncertainty about their futures.

Driven by this crisis, the healthcare system is embracing collaboration and innovation at an unprecedented rate.

Health plans, accountable care organizations and other payer-provider systems are well-positioned to rise to these challenges and embrace these innovation opportunities. My research interviews with dozens of SDOH leaders in healthcare organizations and community-based organizations outline a comprehensive set of initiatives with some impressive results. Many healthcare organizations have already built programs to address SDOH, often in partnership with community-based organizations.

SDOH programs are still relatively new to healthcare. The COVID-19 crisis may be an inflection point that will spur additional investments and initiatives. While certainly not the only path forward, these programs have the potential to quickly address mounting social needs and prevent the associated health complications.

Alexandra Schweitzer
Senior fellow
Mossavar-Rahmani Center for Business and Government
Harvard Kennedy School

Job loss can also mean the loss of health insurance in America’s employer-sponsored system. But single-payer healthcare isn’t the answer to that problem, as a recent letter argued.

Look no further than our neighbor to the north. Canada’s system of socialized medicine limits care access to hold costs down. Canada has just 16 CT scanners for every million people—less than half the ratio in the U.S., according to data from the Organisation for Economic Co-Operation and Development. Canada also has fewer acute-care hospital beds per thousand people than most developed countries.

It should come as no surprise, then, that Canadians wait—and wait—for care. Roughly 30% of Canadians reported waiting four or more hours for emergency care in 2016, nearly three times the share of Americans who reported such waits.

There are better ways to ensure the unemployed have access to affordable coverage—ways that don’t require trillions of dollars in new taxes or long waits for care.

Short-term, limited-duration health plans can provide people coverage while they’re between jobs. Because they don’t have to adhere to all of Obamacare’s cost-inflating mandates, they’re much less expensive.

In the long term, we should consider moving to a system of guaranteed renewable health insurance, under which insurers would be obligated to continue coverage as long as enrollees paid their premiums. Such a system would allow people to purchase plans that met their needs, not their employers’, and take them from job to job.

America’s employer-sponsored health insurance system is not ideal. But single-payer isn’t the answer.

Sally Pipes
President and CEO
Pacific Research Institute