Health-Related Social Needs and Health Care Access and Use by Payer Type

Area of Science:

• Health Services Research
• Social Determinants of Health
• Health Equity

Background:

• Payers and health systems are increasingly focused on addressing health-related social needs (HRSNs) to reduce healthcare utilization and align with value-based care.
• Limited evidence exists on actionable strategies for managing social needs across diverse populations.

Purpose of the Study:

• To investigate the relationship between HRSNs and healthcare access and utilization among adults with Medicare, Medicaid, and private insurance.
• To understand how food insecurity and housing instability affect healthcare access and use based on insurance type.

Main Methods:

• Utilized survey data from the All of Us Research Program (2017-2023; n=126,490) with logistic regression analysis.
• Examined associations between food insecurity and housing instability with having a usual source of care, healthcare provider visits, and forgone care due to cost.
• Stratified analyses by payer type (Medicare, Medicaid, private insurance).

Main Results:

• Prevalence of HRSNs varied significantly by insurance type; food insecurity affected 49.20% of Medicaid beneficiaries (18-64) and housing instability affected 54.61%.
• Food insecurity was linked to lower odds of having a usual source of care (Medicaid, private insurance) and higher odds of forgone care (all payers).
• Housing instability was associated with lower odds of having a usual source of care and higher odds of forgone care across all payer groups.

Conclusions:

• Health-related social needs, specifically food insecurity and housing instability, demonstrate substantial variation by insurance payer.
• These social needs influence healthcare access and utilization differently depending on the payer type.
• Findings can guide the development of payer-specific health management strategies that integrate HRSN interventions.