Effective health care begins well before a patient walks into a doctor’s office or is wheeled into an emergency room.
More and more physicians and health care professionals are recognizing that “social care”—addressing non-medical factors such as housing, education, neighborhood safety and employment—can have a profound impact on peoples’ physical and mental health. And a report released in Washington on Wednesday by the National Academies of Sciences, Engineering and Medicine draws a roadmap for how the U.S. can get there.
The 195-page “Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation’s Health,” was prepared by a blue-ribbon committee of 18 health-care professionals, including Chris Esguerra, M.D., MBA, Senior Medical Director for Blue Shield of California Promise Health Plan. Dr. Esguerra represented the health insurer voice in the national study, lending his expertise and experience from how Blue Shield Promise serves Medi-Cal members in Southern California.
The committee, said Dr. Esguerra, a psychiatrist, set out to “truly promote the holistic treatment of people, to better optimize their social and health care.”
The panel began its work in the spring of 2018. It was chaired by Kirsten Bibbins-Domingo, a vice dean at the University of California at San Francisco.
“Even if people get the best medical care available to them, they may still have poor health outcomes if other social needs such as housing, reliable transportation, or a strong support system at home are not addressed,” said Dr. Bibbins-Domingo.
The report, said Dr. Esguerra, is intended to guide leaders in health care systems, social service organizations, professional schools and government and public policy. Its dozens of specific recommendations are intended to further five broad goals:
- Better integration of social care into health care delivery.
- Supporting and training an engaged, integrated care workforce.
- Develop an infrastructure for data sharing between health and social care.
- Financing the integration of health care and social care.
- Better evaluation of the effectiveness social care practices in health care settings.
According to the report, industrialized nations that devote more resources to social services than health care tend to have better health outcome. In the U.S., for every $1 spent on health care, about 90 cents is spent on social services, while other industrialized countries spend $2 on social services for every $1 spent on health care.
Social services constitute a variety of activities—including home-help for the elderly, rent subsidies, child allowances and credits, childcare support, job training, and disability benefits.
“Integrating social care into health care delivery can be transformative for addressing the individual needs of patients and the collective needs of communities. However, we need the workforce, financing, and infrastructure to do this effectively,” said Dr. Bibbins-Domingo.