Len M. Nichols (
Lauren A. Taylor is a doctoral candidate in health management at Harvard Business School, in Boston, Massachusetts.
Health Aff (Millwood). 2018 Aug;37(8):1223-1230. doi: 10.1377/hlthaff.2018.0039.
Good research evidence exists to suggest that social determinants of health, including access to housing, nutrition, and transportation, can influence health outcomes and health care use for vulnerable populations. Yet adequate, sustainable financing for interventions that improve social determinants of health has eluded most if not all US communities. This article argues that underinvestment in social determinants of health stems from the fact that such investments are in effect public goods, and thus benefits cannot be efficiently limited to those who pay for them-which makes it more difficult to capture return on investment. Drawing on lesser-known economic models and available data, we show how a properly governed, collaborative approach to financing could enable self-interested health stakeholders to earn a financial return on and sustain their social determinants investments.
有充分的研究证据表明，健康的社会决定因素，包括住房、营养和交通等方面，会对弱势群体的健康结果和医疗保健利用产生影响。然而，即使不是所有的美国社区，至少大多数社区都未能获得足够、可持续的资金来实施改善社会决定因素的干预措施。本文认为，对健康社会决定因素的投资不足，是因为这些投资实际上是公共品，因此其收益无法有效地仅限于为其付费的人，这使得投资回报更难以衡量。本文借鉴了鲜为人知的经济模型和现有数据，展示了一种经过适当治理的、协作式的融资方法，如何使利益相关的健康机构能够获得投资社会决定因素的财务回报，并维持其投资。
