Integrating Social and Medical Care: Could it Worsen Health and Increase Inequity?

The Article in Brief

Integrating Social and Medical Care: Could it Worsen Health and Increase Inequity?

Laura M. Gottlieb , and colleagues

Background At a time when health care is increasingly focused on social determinants of health, this essay proposes that focusing on the relationship between patients' social and medical needs may have unintended consequences.

What This Study Found There is a risk, the authors state, that some efforts to incorporate social and economic risk data into health care delivery decisions could worsen health and widen health inequities. Examples include attempts by the Centers for Medicare & Medicaid Services to encourage states to explore work requirements as a condition for Medicaid eligibility, with a rationale based on the health benefits of work and work promotion. According to the authors, such efforts could reduce access to health care by serving as a disincentive to Medicaid enrollment. Other examples include the growing use of social data for commercial health care purposes, which could augment insurance coverage bias and exclusion; and new research on how social deprivation affects biological susceptibility to mental and physical illness, which could shift issues like poverty from the social to the medical realm. To address these issues, the authors call for, "A new dialogue--about both the opportunities and potential consequences of bringing information about patients' social circumstances into a market-based health care system."