Melzer Sanford M
Melzer Healthcare Advisors, Seattle, Washington, USA.
Curr Opin Pediatr. 2022 Feb 1;34(1):8-13. doi: 10.1097/MOP.0000000000001083.
With increasing recognition of the impact of poverty, racism and other social factors on child health, many pediatric health systems are undertaking interventions to address Social Determinants of Health (SDoH). This review summarizes these initiatives and recent developments in state and federal health policy impacting funding for these efforts.
Although the evidence defining optimal approaches to identifying and mitigating SDoH in children is still evolving, pediatric health systems are making significant investments in different initiatives to address SDoH. With limited reimbursement available through traditional payment streams, pediatric health systems and Accountable Care Organizations are looking to value-based payments to help fund these interventions. Federal and state policy changes, including use of Medicaid funds for nonmedical interventions and introduction of the Accountable Health Communities model to pediatrics, offer additional funding sources to address SDoH.
Initiatives among mission-driven pediatric health systems to address SDoH are increasingly common despite funding challenges. Value-based payments, expansion of Medicaid funding resulting from policy changes and delivery system reform, along with health system philanthropy and operating revenues, will all be needed to meet mission-based goals of addressing SDoH while supporting financial sustainability.
随着人们越来越认识到贫困、种族主义和其他社会因素对儿童健康的影响，许多儿科卫生系统正在开展干预措施，以解决健康的社会决定因素（SDoH）。本综述总结了这些举措以及影响这些工作资金的州和联邦卫生政策的最新发展。
尽管确定识别和减轻儿童SDoH的最佳方法的证据仍在不断发展，但儿科卫生系统正在对解决SDoH的不同举措进行大量投资。由于传统支付渠道的报销有限，儿科卫生系统和 accountable care organizations（可问责医疗组织）正在寻求基于价值的支付来为这些干预措施提供资金。联邦和州政策的变化，包括将医疗补助资金用于非医疗干预以及将可问责健康社区模式引入儿科，为解决SDoH提供了额外的资金来源。
尽管存在资金挑战，但使命驱动的儿科卫生系统中解决SDoH的举措越来越普遍。基于价值的支付、政策变化和交付系统改革带来的医疗补助资金的扩大，以及卫生系统的慈善事业和运营收入，都将需要满足在支持财务可持续性的同时解决SDoH的基于使命的目标。
