Oregon Health & Science University.
J Health Polit Policy Law. 2019 Dec 1;44(6):919-935. doi: 10.1215/03616878-7785823.
States and policy makers have expressed a strong interest in using Medicaid to address social determinants of health (SDOH). While this approach holds promise for improving outcomes and reducing costs, using Medicaid to pay for services outside the medical system creates challenges. This article examines efforts to address SDOH in Oregon, which, as part of its 2012 Medicaid waiver, incorporated health-related services that lacked billing or encounter codes and were not included in Oregon's Medicaid state plan as a strategy to improve outcomes and control costs. We examine the varieties of health-related services that were used and describe the specific challenges in deploying and paying for these services. We conclude with lessons from Oregon that can help states and the federal government as they work to address SDOH.
州和政策制定者对利用医疗补助（Medicaid）来解决健康的社会决定因素（social determinants of health，SDOH）表现出浓厚的兴趣。虽然这种方法有望改善结果并降低成本，但利用医疗补助来支付医疗体系之外的服务费用会带来挑战。本文考察了俄勒冈州在解决 SDOH 方面的努力，作为其 2012 年医疗补助豁免的一部分，该州将缺乏计费或就诊代码且未包含在俄勒冈州医疗补助州计划中的与健康相关的服务纳入其中，以此作为改善结果和控制成本的一种策略。我们考察了所使用的各种与健康相关的服务，并描述了部署和支付这些服务所面临的具体挑战。最后，我们总结了俄勒冈州的经验教训，这些经验教训可以帮助州和联邦政府在努力解决 SDOH 问题时提供参考。
