The COVID-19 pandemic has laid bare major fault lines in the U.S. healthcare system and has resulted in a massive rethinking around how to better address the health and well-being of Americans. So much so that the Physicians Foundation updated the format of the 2020 edition of their biannual Survey of America's Physicians to focus on COVID-19's impact—specifically on physicians' practices and their patients, physician well-being, and the future of healthcare in the U.S.
Among the key findings in the report's third section are several that highlight the roadblocks physicians see in better addressing the social determinants of health (SDoH) in their practices, giving us a lay of the land when it comes to how SDoH are factored in our healthcare system—both directly and indirectly:
- 73% of physicians think SDoH will drive demand for healthcare services in 2021.
- 89% of physicians agree that providing affordable health insurance is the most crucial policy step for ensuring access to high-quality, cost-efficient care for all.
- 70% of physicians agree that insurance companies should factor in access to healthy food and safe housing into risk scoring formulas that determine patient complexity.
- More than two-thirds of physicians (67%) indicate that 11% or more of their patients delay or decline treatment due to costs—and 44% of physicians say that more than 26% of their patients do the same.
Ready to dive into more of the report's findings? Let's unpack four areas that take a look at the relationship between SDoH and healthcare in the U.S. in 2021 and beyond.
Doctors want to address SDoH when caring for patients, but there are limited tools available and they're not being reimbursed for those efforts.
Physicians surveyed were asked to rate various policy steps that could be taken to ensure high-quality, cost-efficient care for all given our current healthcare infrastructure. Sixty-three percent of respondents rated reimbursing physicians for addressing SDoH as an important or very important policy step to take.
While it should be a celebration that nearly two-thirds of doctors are honing in on SDoH and how they relate to positive patient outcomes, it's clear that there are still miles to go to make SDoH a major consideration in healthcare delivery in the U.S.
Not only did more physicians indicate that policy goals related to streamlined authorizations, surprise medical billing, reimbursement for telemedicine services, and simplified access to mental health services were more important, 17 percent of respondents noted SDoH reimbursement as of little or no importance—representing nearly three times as many physicians as any other policy goal included in the survey.
There's a disconnect here, given that social and economic factors are often cited as the largest factor in determining health outcomes—as much as 80 percent, in fact. But despite those overwhelming statistics, physicians largely feel that their hands are tied: They have few tools at their disposal for improving patient conditions caused by SDoH, and they're largely uncompensated for their efforts to address the SDoH affecting their patients' health.
In a healthcare system that prioritizes treatment of acute illness rather than preventative care and SDoH, physicians are being left to their own devices to factor social risk into their practices.
Health inequities have to be eliminated to ensure high-quality healthcare for all
Physicians were also asked to consider the next five years of the U.S. healthcare system and determine how important various policy goals were to achieving high-quality care for all citizens, no matter their need. Presented alongside options that address transparency of medical costs, health system consolidation, and clarifying the effect of Pharmacy Benefit Managers, 75 percent of respondents said reducing health inequity and inequality of access was deemed important or very important.
And those physicians have the right to be concerned about the impact of healthcare inequality in this country, given that life expectancy can vary greatly based on a person's zip code alone. In 2019, the New York University School of Medicine found that life expectancy for Chicago residents varied by more than 30 years, depending on where in the city they live.
When social conditions can change within a few blocks or miles that shave decades off of a resident's life, it's clear that work needs to be done to address and improve those conditions.
COVID-19 has only deepened concerns about healthcare availability—and demand
Anxiety. Isolation. Layoffs (and the resulting loss of health insurance that came with those jobs). For nearly a year now, the pandemic has caused seismic changes in how people lead their everyday lives—and that has taken a toll on mental and physical well-being. In the first months of the pandemic, the Kaiser Family Foundation survey found that nearly half of all U.S. adults (45 percent) said the pandemic has affected their mental health, with 19 percent saying it's had a major impact.
So it shouldn't be surprising that mental health services are in greater demand than ever. But meeting all of those patients' needs is going to be a tall order to fill, even with 86 percent of physicians surveyed by the Physicians Foundation citing simplified access to integrated mental health services as important or extremely important to providing healthcare for all. That's largely due to the ongoing, critical shortage of psychiatrists seen across 77 percent of U.S. counties, according to a National Council of Behavioral Health report.
Also exacerbated by the pandemic are health inequities experienced by race. Not only have Black Americans been infected with COVID-19 at three times the rate of white Americans, but they're twice as likely to die from the virus. And Latino populations are seeing the highest rate of transmission, too: 73 cases per 10,000, compared with 62 for Black Americans, and 23 for whites.
Considering that Black and Latino Americans are far more likely to experience the social inequalities that accompany poor access to quality healthcare, this is a care gap in the country's battle against the pandemic that needs more attention.
Shining a light on SDoH in 2021 and beyond
When it comes to forging a path forward for healthcare in the U.S., the system seems to be caught in a paradox akin to that of the chicken and the egg: Which comes first—addressing chronic illness or the social needs that cause them?
Nearly all respondents (94 percent) cited chronic conditions such as heart disease, diabetes, and kidney disease as placing the highest demand on the healthcare system in 2021. Meanwhile, only 73 percent see health-related social needs like access to healthy food, safe housing, transportation in the same light.
Six in 10 adult Americans have one chronic disease and four in 10 have two or more, according to data from the Centers for Disease Control, causing tremendous stress on healthcare systems across the country. But that's because our current system is designed to treat illness as it arises, not to prevent the root causes and conditions causing the disease. So to truly move the needle on positive patient outcomes and make America a healthier, more equitable place for all, addressing the social determinants of health has to be prioritized even further.
At the end of the survey, when asked for a statement to the public and policymakers about the state of the medical profession today and how health care delivery can be improved, one respondent's answer presented a clear throughline between SDoH and chronic illness:
"Investing in social determinants of health is of utmost importance, as they cause or complicate every chronic condition."
In this light, Healthify's mission, to help build a world where no one's health is hindered by their need, becomes even more critical in the years ahead. We're working to provide solutions where healthcare organizations and communities can come together to help people thrive—from building partnerships that address social needs to leveraging new technologies that make data around social services and population needs at the community level more accessible.
Read about the progress we were a part of to address SDoH in 2020, and learn more about the ways Healthify supports comprehensive care coordination every day across our networks of healthcare and community-based organizations.