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January 29, 2018

Why America may spend too much on health care—and not enough on people

Daily Briefing

    By Scott Orwig, Senior Manager

    Among wealthy nations, the U.S. ranks first by far in health care spending—but last in life expectancy. As a recent Politico story by David Freedman explains, one source of this discrepancy may be that America spends far less than most developed nations on social services such as housing, food, and education.

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    That exposes a shortcoming of U.S. policy debates, argues Freedman, a contributing editor at The Atlantic and co-founder and executive editor of Global HealthCare Insights Magazine. "When we debate housing services, or education spending, we rarely focus on their potentially huge downstream benefits on public health," he writes. "And when we debate health care spending, we don't discuss the lack of 'upstream' social services that has made much of that care necessary."

    The 'most bang for the buck in health outcomes'

    A "great deal" of research indicates that social service spending has a major effect on health, Freedman writes. For instance, a 2016 study published in Health Affairs by Elizabeth Bradley and colleagues found that U.S. states with higher ratios of social service spending to health spending have better-than-average outcomes across several metrics, including incidence of asthma, obesity, and type 2 diabetes.

    "The right question for our political agenda is, 'What's going to give us the most bang for the buck in health outcomes?" Bradley tells Freedman. "What our work has shown is that the answer is spending on social services."

    In an analysis of 74 studies, Bradley, now the president of Vassar College, and Lauren Taylor found that three social service interventions can have a "particularly meaningful" effect on reducing health costs:

    • Housing support;
    • Nutrition support; and
    • Certain case management and outreach programs.

    Freedman suggests there are two major reasons why policy conversations have historically focused so little on the connection between social services and health: that robust studies on the subject are fairly new, and that many social service investments require lawmakers to stomach short-term costs for longer-term gains.

    Still, providers, health departments, community-based organizations, and some politicians are forging ahead on addressing the social determinants of health, in part by pursuing projects that can reduce health costs in the short term—such as subsidized housing programs for at-risk patients—and by prioritizing community partnerships.

    Making the business case for community partnership

    It's not just policymakers: Health system leaders often need to be convinced of the link between community health projects and the system's strategic goals, too. In Population Health Advisor's study "Building the business case for community partnership," Advisory Board experts outline four steps for forging partnerships that fulfill both strategic and population health goals:

    1. Engage leadership by building a compelling business case to garner executive buy-in and needed resources;
    2. Prioritize initial focus by determining what services or programs to start with, recognizing process will be iterative;
    3. Build or strengthen partner relationships by leveraging unique strengths of community organizations to extend care team reach; and
    4. Design screening and referral protocols to clearly link these two steps and ensure timely follow-through and improved patient and provider satisfaction.

    University of Vermont Medical Center (UVMMC), a 562-bed medical center in Burlington, Vermont, has found success by investing in social services and community partnership.

    UVMMC has partnered with a local affordable housing nonprofit and community health centers to house and provide clinical services to patients with short-term, medium-term, and permanent housing needs. Among patients in its short-term units, the program has decreased inpatient admissions from 95 to 30 stays and ED utilization from 161 to 94 visits. Meanwhile, the health care costs for patients in its 18 single-unit apartments for indefinite stays have declined $750,000 to $250,000.

    To learn more about UVMMC's program and see how other organizations are addressing housing insecurity, read our report "How to Close the Housing Gap Through Strategic Partnerships," and register for our webconference with UVM Health Network's Chief Population Health and Quality Officer.

    Next, learn more about addressing health inequities

    Join us for a webconference on Feb. 1 that will highlight the importance of prioritizing health care disparities and outline the primary methods, key stakeholders, and critical tools for identifying your community's most pressing needs.

    Register Now

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