Berkowitz Seth A, Edwards Samuel T, Polsky Daniel
Seth A. Berkowitz (
Samuel T. Edwards is an assistant professor of medicine at Oregon Health & Science University and a staff physician in the Section of General Internal Medicine, Veterans Affairs Portland Health Care System, both in Portland, Oregon.
Health Aff (Millwood). 2020 Apr;39(4):582-586. doi: 10.1377/hlthaff.2019.01579.
Health-related social needs, which include food insecurity, housing instability, and lack of transportation, are strongly associated with poor health outcomes, more health care use, and higher health care spending. Integrating human services that address health-related social needs into health care may address these issues. In this article we propose an innovative methodological approach (borrowed from developmental economics) called cash benchmarking, which can help determine when health care and human services integration is most useful. This is important because while integrating human services into health care offers potential benefits, it also comes with potential downsides-including the medicalization of social needs; deemphasis of upstream societal causes of health-related social needs, such as tax policy and labor conditions; and opportunity costs within the health care system, as resources are shifted to delivering social care. Ultimately, cash benchmarking can help stakeholders navigate closer to the promise, and away from the pitfalls, of health care and human services integration.
与健康相关的社会需求，包括粮食不安全、住房不稳定和交通不便，与不良健康结果、更多的医疗保健使用以及更高的医疗保健支出密切相关。将解决与健康相关社会需求的人类服务纳入医疗保健可能会解决这些问题。在本文中，我们提出了一种创新的方法论方法（借鉴发展经济学），称为现金基准法，它可以帮助确定医疗保健与人类服务整合何时最有用。这很重要，因为虽然将人类服务纳入医疗保健有潜在好处，但也存在潜在弊端，包括社会需求的医学化；对与健康相关社会需求的上游社会原因（如税收政策和劳动条件）的忽视；以及医疗保健系统内的机会成本，因为资源被转移用于提供社会护理。最终，现金基准法可以帮助利益相关者更接近医疗保健与人类服务整合的前景，同时避免其中的陷阱。
