July 11th, 2024 2 Minute Read Press Release

New Report: Is Everything Health Care? Evaluating Social Determinants of Health (SDOH)

Evidence supporting the benefits of SDOH spending is thin

NEW YORK, NY – In a world where childcare is infrastructure, is housing now health care? That’s a premise that some policymakers in the White House currently advance. They claim that addressing what they call social determinants of health (SDOH)—vague, nonmedical social factors like housing and education—will translate into long-term reductions in health spending. But in a new report for the Manhattan Institute, senior fellow Chris Pope finds the evidence driving SDOH spending is thin, based on questionable premises and bad research design.

The philosophy of SDOH is articulated in a 53-page document the Biden White House released in November 2023, called the U.S. Playbook to Address Social Determinants of Health. It suggests that addressing “social circumstances” and “environmental hazards” like toxic stress and housing insecurity will mitigate conditions like anxiety, heart disease, and stroke, thus translating into long-term health-care savings. Nudged by taxes, subsidies, and regulations driven by this justification, major health-care corporations like UnitedHealthcare, Centene, and Humana are investing billions of dollars into building “affordable housing” and furnishing vague community resources.

But according to Pope, their money would be better spent on more targeted expenditures. The best-designed studies evaluating social theories of health find only weak outcomes. What’s more, policies based on SDOH logic enable states to access federal matching funds that should otherwise be allocated to health-care expenditures with more tangible results.

Pope writes that rather than expanding health-care programs to pay for more nonmedical services, policymakers should:

  • Resist pressure to expand the capacity of states to claim federal Medicaid funding for purposes beyond the program’s core covered benefits.
  • Not establish additional payments in Medicare for health-care providers to address SDOH beyond incentives inherent in medically risk-adjusted payments to Medicare Advantage plans.
  • Oppose efforts to make insurers, hospitals, or other medical providers responsible for addressing SDOH with tax or payment incentives.

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