More on Population Health

Social determinants of health pose challenges for most Americans, survey shows

Improving social determinants for patients can have strong positive effects on the patient's health and decreased costs for the healthcare system.

Jeff Lagasse, Associate Editor

If healthcare leaders still need evidence that it's wise to address social determinants of health, one more indication has come in the form of a new Waystar survey, revealing that 68 percent of Americans identified having challenges in at least one SDoH risk category.

Of all patients in the "high risk" segment, 60 percent have never discussed their issues with a provider or their insurance company.

SDoH categories included financial or food insecurity, social isolation, housing insecurity, addiction, transportation access and health literacy. Consistent across payer classes (government-funded versus commercial insurance), the most commonly reported SDoH issues were financial insecurity and social isolation.

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Improving these patient concerns can have strong positive effects on the patient's health and the country's overall healthcare system, because addressing the social determinants has been shown to decrease healthcare costs.

But in an era of health system transformation, providers, healthcare organizations and payers still largely lack the tools, programs, and community partnerships required to identify and address the patient needs, the study found. 

The data identified an exponential relationship in missed medical appointments related to increased SDoH risk. And the survey also found that efforts to identify and mitigate SDoH risk are far from universal. The findings show only 22 percent of consumers with SDoH stress have discussed these issues with their physician.

Efforts to engage patients on SDoH issues are also found to be frequently misapplied, with the majority of conversations about SDoH challenges occurring with the patients least likely to be affected by them -- and less likely to accept assistance even if they are affected.

As a result, 46 percent of patients who are offered programs and services to help address SDoH challenges decline to accept.


Medicare and Medicaid have the largest high-stress share with 33 percent having high stress in three or more areas, compared to 21 percent of the commercial insurance population being "high risk."

While almost half decline assistance, those who discuss SDoH challenges with a physician or nurse are more likely to accept help than those who speak with an insurance representative.

Younger consumers are twice as likely to have been engaged in a discussion of their SDoH challenges but are less receptive to assistance.


Research published earlier this autumn finds that the overall well-being of a population on a county level is associated with lower healthcare spending for each Medicare fee-for-service beneficiary.

The findings suggest that certain population health and social determinants programs, such as interventions that improve access to populations for basic resources, including access to healthcare, or improve social connection and emotional health for populations, may not only increase well-being but also result in reduced healthcare spending.

Twitter: @JELagasse

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