Abstract
We summarized the recently published, peer-reviewed literature that examined the impact of investments in social services or investments in integrated models of health care and social services on health outcomes and health care spending. Of 39 articles that met criteria for inclusion in the review, 32 (82%) reported some significant positive effects on either health outcomes (N = 20), health care costs (N = 5), or both (N = 7). Of the remaining 7 (18%) studies, 3 had non-significant results, 2 had mixed results, and 2 had negative results in which the interventions were associated with poorer health outcomes. Our analysis of the literature indicates that several interventions in the areas of housing, income support, nutrition support, and care coordination and community outreach have had positive impact in terms of health improvements or health care spending reductions. These interventions may be of interest to health care policymakers and practitioners seeking to leverage social services to improve health or reduce costs. Further testing of models that achieve better outcomes at less cost is needed.
Highlights
Social determinants of health have taken center stage in recent health policy discussions, with the growing emphasis on global payment, accountable care organizations (ACO) [1], and other initiatives focused on improving population health
We summarized the peer-reviewed literature that examined the impact of investments in social services or investments in integrated models of health care and social services on health outcomes and health care spending
One study[19] reported significantly increased obesity associated with food assistance in a sample of adult Supplemental Nutrition Assistance Program (SNAP) recipients, and one study [40] reported mixed results, showing that participation in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) was associated with significantly higher birth weights, but this result was sensitive to model estimation parameters such that this result was only observed in fixed effects models
Summary
Social determinants of health have taken center stage in recent health policy discussions, with the growing emphasis on global payment, accountable care organizations (ACO) [1], and other initiatives focused on improving population health. Many researchers have examined the relative contributions of health care services, genetics, behaviors, environment and social factors in promoting health and reducing premature mortality [3,4,5,6]. The literature has not yet been reviewed comprehensively to generate an integrated, evidence-based summary of how to best address the social determinants to achieve positive health effects without increasing, and perhaps even decreasing, health care spending. We sought to synthesize the existing empirical evidence about the impact of social service interventions on health outcomes and health care spending, with particular attention to identifying programs and practices that achieved both improvements in health as well as potential reductions in health care spending
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