Social Determinants of Health Are Important, but Who Is Responsible for Addressing Them?

Although the importance of addressing social determinants of health (SDOH), such as food insecurity and housing instability, has become apparent, how to properly address these social determinants, and who should do so in the clinical environment, is less clear. According to a Leavitt Partner survey, the majority of physicians generally believe SDOH matter for their patients, but they do not believe that it is their responsibility to address them and do not feel well-positioned to do so.

The survey of 621 physicians was administered from June 2017 through July 2017. Throughout the survey, approximately 75% of physicians indicated that informing patients about the price of care and about health insurance, such as enrolling in public health insurance plans, would help them to a great or moderate extent. Additionally, 66% reported that they believe assistance in arranging transportation for healthcare would aide their patients to a great or moderate extent.

Over half (54%) also said that increasing patient income would assist their patients to a great or moderate extent, 48% indicated that help with food security would benefit their patients, and 45% reported that assistance with affordable housing would help their patients. Those who had been practicing for less than 20 years were significantly more likely to believe that increased income and assistance with arranging transportation would benefit their patients to a great or moderate extent.

Physicians with practices that had 30% or more of their patients on Medicaid were more likely to believe that increased income, affordable housing, and assistance with transportation would benefit their patients.

However, the majority indicated that they did not feel responsible for addressing these social needs. Over 90% reported that the doctor or insurer is not responsible for help with affordable housing or increased income, 84% reported that they were not responsible for assisting with food security, and 69% said they were not responsible for arranging transportation.

Physicians cited multiple reasons behind not being able to address these needs for the patients, including believing these factors are not within the capability of the physician's office, insufficient appointment duration, and lack of compensation for this type of assistance. They also reported that they believe patients have other resources for these social needs.

Among those who indicated that they believe physicians and insurers should help address patients’ social needs, the majority did not feel well positioned to do so. When asked who is best positioned to help patients, most indicated someone outside of the practice, but some believe that someone else in the office—either medical or administrative staff—is well-positioned.

Noting the prominence of physician burnout, the authors of the report argue that solutions to addressing SDOH must seek to reduce, not exacerbate, the burden on providers. They also note that these efforts must be matched by other sectors, such as employers, as addressing these needs is not solely the responsibility of those in the clinical setting.

“Although physicians can take steps within their own practices to help patients with their social needs and employers can help organize their communities, a broader societal investment in public health and social services is necessary,” they wrote. “Meaningfully addressing SDOH without adding to physician burden depends on channeling sufficient commitment and resources toward programs and policies that help physicians incorporate these social considerations in their practices.”