The conversation about how best to reform our health care system has largely centered on the battle over legislation. But underlying the contentious discussion over who and what should be covered by health insurance and the cost is an often overlooked aspect I contend is equally important to the health of our citizenry: the factors outside of the doctor’s office that help us stay healthy.
The conditions in which you live; whether you have transportation to a clinic when needed; your support network and other factors beyond the doctor’s office are as important to your overall health and well-being as being treated for an illness. Research has shown that while genetics certainly play a role, at least 60 percent of health outcomes are a result of circumstances outside of the health care system. A 2013 study by the Commonwealth Fund compared the United States with other industrialized countries’ spending on health care vs. non-clinical needs. In all the other countries studied, more of the gross domestic product was devoted to what the study termed “social care” then “health care.” Interestingly, on measures of population health, like infant mortality, prevalence of chronic conditions and life expectancy, the United States fared worse than our international peers.
Studies have clearly demonstrated that when economic, environmental and social needs are addressed, health care costs go down, health outcomes improve and patients and physicians are happier.
As we look for new and innovative ways to contain costs and improve the health of our community, awareness is building around the importance of addressing non-clinical factors. First, those involved in caring for people both in and out of the clinical setting are breaking down the boundaries that used to separate us. The N.C. Medical Society (NCMS), health systems, community organizations, patient advocates and the N.C. Department of Health and Human Services (NCDHHS) are collaborating on ways to best serve the needs of the patient both inside and outside the medical setting. North Carolina has an opportunity to be held up as a national example of how to build coalitions to address these needs while improving access to quality health care and reducing costs.
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One example of this ongoing conversation: the fall meeting of the N.C. Population Health Collaborative focused on addressing these non-clinical determinants of health. Participants heard about innovative projects already underway, like the Patient Assistance Center in New Hanover Regional Medical Center’s emergency department, which connects patients with community services at their time of most acute need; the Triad Area Agency on Aging’s ongoing work with older adults in their homes; and the innovative approach Cherokee Hospital is taking to build meaningful community connections to promote good health.
The Collaborative also welcomed NCDHHS Secretary Mandy Cohen, a medical doctor who clearly understands the importance of these key drivers of health from her experience as a practicing physician. She is committed to addressing these needs and incorporating this philosophy in the state’s Medicaid reforms wherever possible and possesses the skills and expertise to be successful.
Patients and physicians alike support this more complete view of health. Our members see firsthand the connection between poverty and other factors on health outcomes and cost, and generally believe quality care includes addressing health-related social needs.
Successfully improving health while reducing costs also depends on innovative payment and care delivery models – no small task and one we are all grappling with as our health care system undergoes much needed change. Research data shows, however, that continuing to ignore the impact of unmet environmental, economic and social needs relegates patients to adverse health outcomes throughout their life.
Strong leadership and initiative are needed from physicians and hospital systems and every concerned group and health care professional with a stake in and the professional responsibility for our health care system.
Robert W. Seligson is executive vice president and CEO of the N.C. Medical Society.