Social Risk Factors and Their Effect on Health Care Costs in a Midwestern Health Care System

Area of Science:

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

Background:

• Social risk factors and socioeconomic status (SES) are recognized determinants of health.
• Understanding their impact on healthcare costs is crucial for resource allocation and policy development.
• Previous research has indicated a link between social determinants and healthcare expenditures.

Purpose of the Study:

• To evaluate the association between social risk factors and socioeconomic status (SES) with healthcare costs.
• To analyze these effects within a large, integrated health system in the Midwestern US.
• To identify specific social risk factors contributing to increased healthcare spending.

Main Methods:

• Retrospective review of administrative patient cost data from 410,624 patients across 45 clinics.
• Identification of social risk factors (e.g., food insecurity, housing instability) via patient questionnaires.
• Objective SES determination using a housing-based measure; cost z-scores compared across quartiles.

Main Results:

• Higher social risk was associated with increased mean cost z-scores (0.38 for high risk vs. 0.11 for low risk; P < .001).
• Increased costs correlated with age, medical complexity, White race, and lack of financial resources.
• No significant cost differences were found across SES quartiles or between urban/rural locations.

Conclusions:

• Patient-reported social risk factors demonstrated a significant association with higher healthcare costs in the studied health system.
• Multivariate analysis revealed a substantial decrease in these associations after adjusting for other variables.
• Findings should be cautiously applied outside the Midwestern US due to potential biases and cohort homogeneity.