- Rural, critical access and safety net hospitals have not expanded initiatives to address social determinants of health in vulnerable patient populations, and some are implementing fewer such strategies, according to an analysis of survey data collected during the first year of the COVID-19 pandemic. Efforts to develop community partnerships especially have lagged.
- Insufficient financial and community resources, workforce constraints, limited institutional partnerships and a lack of incentives were among the possible explanations for the stalled momentum offered by researchers from the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital.
- For state and federal policymakers looking to alleviate health inequities by implementing programs focused on social needs, addressing resource barriers that hospitals serving vulnerable populations face should be a priority, the researchers said in a report published in JAMA Health Forum.
The findings from Harvard and Brigham and Women’s follow years of increased attention to the importance of social determinants such as housing, employment, education and food security to patient health.
Previous research has found that social factors account for more variation in health outcomes than medical care does. The Affordable Care Act in 2010 mandated that tax-exempt hospitals conduct community needs assessments every three years and participate in community-level planning to improve health outcomes.
The new study tracks with research conducted at New York University that suggested a hesitancy to invest in social determinants programs, possibly due to limited evidence of their effectiveness. That report found U.S. health systems invested at least $2.5 billion in such programs from 2017 to 2019, but spending on community-based activities had not increased as of 2014 despite the ACA requirements.
Programs focused on social determinants for Medicaid patients may help reduce unnecessary healthcare use but can be expensive to operate, another study, published this summer in the Annals of Internal Medicine, showed.
In the latest research, the investigators looked specifically at how facilities that serve vulnerable populations are addressing social determinants of health, using data from more than 2,700 hospitals in a 2020 American Hospital Association survey. The results showed rural hospitals screened for a similar number of social determinants as urban hospitals but implemented fewer programs, interventions or community partnerships.
The level of screening at critical access hospitals was similar to non-critical access hospitals, but the former addressed fewer social needs and reported fewer community partnerships. Safety net hospitals also reported fewer community partnerships compared to non-safety net hospitals.