Health-Related Social Needs and Total Healthcare Cost: A Cross-Sectional Study in a Large Integrated Health System.

BACKGROUND

While research on health-related social needs (HRSNs) has expanded, important gaps remain in understanding associations between HRSN and healthcare cost, especially across general populations of patients with broad-ranging medical and social needs.

OBJECTIVE

To examine the association between HRSN and healthcare cost in a large, diverse, insured population.

DESIGN

In this cross-sectional study, we evaluated cost differences between patients with different HRSN levels using survey-weighted multivariable generalized linear models. We examined three alternate model specifications: one that included controls for basic demographics; another adding insurance type, race/ethnicity, and social isolation; and a third adding a diagnosis-based medical risk index called DxCG. Variables added in the latter models were assessed separately due to concern for over-correlations with HRSN.

PARTICIPANTS

10,226 adult survey respondents (23% response rate) from eight states and Washington, D.C.

MAIN MEASURES

The primary exposure was patient-reported HRSN, based on survey questions asking about financial strain, food insecurity, housing instability, and transportation difficulties. HRSN was constructed as a three-level variable. The primary outcome was total direct healthcare cost.

KEY RESULTS

"Moderate HRSN" was not significantly associated with cost in any model. In the model controlling for patient demographics, costs for patients with "Severe HRSN" were 1.27 (95%CI: 1.00-1.60) times those of patients with "No HRSN." In a model that adjusted for medical risk (DxCG), the relationship between HRSN and cost was not statistically significant.

CONCLUSIONS

Relationships between HRSN and healthcare cost may vary by HRSN level. Our mixed findings highlight the complex relationship between medical and social risks, which often have bi-directional causal relationships. If measures of medical risk incidentally capture variation in social risk, then models controlling for medical risk may mask relationships between HRSN and cost. Further studies should investigate the extent to which HRSN may be related to cost, even when controlling for specific patient diagnoses.