Health-Related Social Needs and Total Healthcare Cost: A Cross-Sectional Study in a Large Integrated Health System

Area of Science:

• Health Services Research
• Social Determinants of Health
• Health Economics

Background:

• Research on health-related social needs (HRSN) is growing, yet understanding its impact on healthcare costs across diverse populations remains limited.
• Gaps exist in knowledge regarding the association between HRSN and healthcare expenditures, especially in general patient populations with varied medical and social challenges.

Purpose of the Study:

• To investigate the relationship between health-related social needs (HRSN) and healthcare costs within a large, diverse, and insured patient group.
• To analyze how different levels of HRSN correlate with total direct healthcare expenditures.

Main Methods:

• A cross-sectional study involving 10,226 adult survey respondents from eight states and Washington, D.C.
• Patient-reported HRSN (financial strain, food insecurity, housing instability, transportation difficulties) was assessed and categorized into three levels.
• Survey-weighted multivariable generalized linear models were used to evaluate cost differences, with models adjusted for demographics, socio-economic factors, and medical risk (DxCG).

Main Results:

• Moderate HRSN showed no significant association with healthcare costs across all models.
• Patients with severe HRSN had 1.27 times higher healthcare costs compared to those with no HRSN in a model controlling for demographics.
• When adjusted for medical risk (DxCG), the association between severe HRSN and healthcare costs was no longer statistically significant.

Conclusions:

• The association between HRSN and healthcare costs may be dependent on the level of social need.
• The findings suggest a complex interplay between medical and social risks, potentially with bidirectional causality.
• Controlling for medical risk measures might mask the true relationship between HRSN and healthcare costs, necessitating further investigation into these complex interactions.