In a recent JAMA Network Open study, French researchers from Inserm and public assistance hospitals in Paris found that a pediatric patient’s socioeconomic status is strongly linked to length of stay and the overall cost of care. They suggested that reforming hospital payments to offset such social determinants of health (SDoH) could both help hospitals reduce their costs while improving the quality of care for such vulnerable patients.
While it might be easy to say France’s healthcare system is too different to draw comparisons, Matthew Davis, MD, MAPP, interim chair, department of pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine, and colleague Kristin Kan, MD, MPH, MSc, published an invited commentary in the same journal issue arguing that the United States could also benefit from adjusting Medicaid payments in order to better provide care and support to lower income pediatric patients.
“If the healthcare industry does not consider social determinants of health, the industry will continue to ignore a major influence on patterns of health and health care utilization,” Davis says. “Over the last 10 to 20 years, the healthcare industry has invested healthy in analytics and interventions that try to leverage typical tools of healthcare itself. While those will continue to be important going forward, the leaders in the healthcare industry will be the ones who are able to distinguish themselves by understanding social and environmental influences on child and adult health—and acting to address them in partnership with patients and providers.”
Recent evidence suggests the absence of SDoH considerations in reimbursement models fundamentally distorts payment patterns for the hospitals that are more likely to serve more economically disadvantaged populations. Davis said this is a big problem—and one that has many unintended consequences for balancing costs and care.
“When such hospitals—which often are academic medical centers—experience payments that are lower than needed to appropriately care for individuals at socioeconomic disadvantage, then the academic resources and medical know-how of such institutions are put at risk for all of their patients, from across all socioeconomic strata, not just the populations that are socioeconomically disadvantaged,” he says.