Over the past couple of weeks, we have focused on the importance of addressing the social determinants of health – the conditions that affect health outcomes such as affordable housing, access to healthy food, education, public safety, education, and poverty. Recent data show that these social determinants affect both consumer health outcomes and health care costs – Food Insecurity And Health Outcomes, The Association Between Income and Life Expectancy in the United States, 2001-2014, and Neighborhood Socioeconomic Disadvantage & 30-Day Rehospitalization: A Retrospective Cohort Study.
There are two perspectives to this issue. First, there is the consumer-centric perspective, or the need for a holistic approach for supporting consumers where medical, behavioral, and social services are provided in a coordinated fashion. The second is the policy perspective, or the need to balance U.S. spending on “health care” with spending on “social services.”
The Consumer Perspective – The consumer perspective confronts managers of organizations in the field on a day-to-day basis. And over the past few weeks, I have tried to provide an overview of the programs available to consumers to address their social service needs. There are three major categories of non-health social service programs.
- Income assistance provides mainly cash benefits
- Nutrition assistance provides vouchers to purchase food
- Housing assistance provides subsidies for low-income renters
The challenge is to navigate the various programs and their eligibility requirements. In total, there are nine major social service programs with a variety of smaller housing and nutrition assistance programs. Each of these programs has a unique set of benefits for an eligible subset of the population, such as families with children, disabled individuals, or mothers and children. These programs and a general description of the eligibility requirements are outlined below.
Major U.S. Non-Health Social Services Programs
|Temporary Assistance For Needy Families (TANF)||Cash benefit and non-cash benefits (child care, work supports, transportation, etc.)||Able-bodied families with at least one child and low-income|
|Supplemental Security Income (SSI)||Cash benefit||Aged, blind, or disabled individuals with low-income|
|Pell Grants||Cash benefit||Students attending post-secondary school meeting income requirements|
|Federal Earned Income Tax Credits||Cash benefit||Individuals or families with low-income who fill-out a tax return|
|Supplemental Nutrition Assistance Program (SNAP)||Electronic benefit transfer to purchase any food item||Families and individuals with gross monthly income below 130% of the FPL and net monthly income below 100% of the FPL|
|Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)||Electronic benefits or vouchers to purchase specific food items included in food package||Children 0-5, pregnant women, and post-partum women with income below 185% of the FPL|
|Child Nutrition Programs||Meals (breakfast, lunch, snacks)||Children in a participating K-12 institution or child care facility with family income below 185% of the FPL|
|Tenant-based Rental Assistance||Voucher to subsidize housing on the rental market||Individuals or families with income below 50% of the area median income|
|Project-based Rental Assistance||Subsidized housing attached to a privately owned unit||Individuals or families with income below 50% of the area median income|
|Public Housing||Subsidized housing owned and operated by the federal government||Individuals or families with income below 50% of the area median income|
|Other Housing Assistance Programs||Homeless assistance programs, Section 811 housing for the disabled, HOME partnerships||Eligibility varies based on the program|
For more on these programs, make sure to check out these resources from the OPEN MINDS Industry Library – Getting SSI Income Assistance For Consumers With Disabilities, Helping The Consumers Who Need Income Assistance Navigate SSI & SSDI, Helping Low-Income Consumers Access The Resources They Need, and Helping Consumers With Food Insecurity: What Services Are Available?.
The Policy Perspective – The perpetual policy question is whether or not U.S. spending on health care is in balance with U.S. spending on social service programs. The answer is that the balance is clearly weighted towards health care. In FY2014, the U.S. spent $3 trillion on health care expenditures and accounted for 17.5% of gross domestic product (GDP) (see NHE Fact Sheet). In comparison, the U.S. spent $335.8 billion on federal social service programs, or 1.9% of the GDP. When education, unemployment programs, and other social service programs are factored into the equation, social service spending rises to 9% of GDP.
By comparison, other high-income countries (France, Sweden, Canada, Australia, Norway, and the United Kingdom) all spend a higher percentage of their GDP on social services instead of health care (see U.S. Health Care from a Global Perspective). For example, France spends 12% of its GDP on health care and 21% on social services; and the United Kingdom spends 8% of their GDP on health care and 15% on social services. And these countries perform better than the U.S. in many important health indicators such as life expectancy at birth, infant mortality rates, and the prevalence of chronic diseases (see U.S. Health Care from a Global Perspective).
These statistics lead to many questions on U.S. spending. Should the U.S. spend more on social service programs? If spending on social services increased would health spending drop and better health outcomes occur?
And perhaps most relevant for provider organization executives, what is the role of health care in providing whole person care? In order to improve health care outcomes, it is important to help consumers access social service programs, but health care cannot (and probably should not) be responsible for the provision of all consumer needs. I expect that in the next couple of years the U.S. will have to address the roles of health care and social service programs and we may see a shift in how we pay for and view these programs.
For more on the social service programs, including spending over time on each program, the number of participants over time, and more detailed information on eligibility requirements and benefits, see What Is The Size Of The Social Service Market & How Has It Changed Over Time?: An OPEN MINDS Market Intelligence Report. The report answers a number of key questions, including:
- What Is The Size Of The Social Service Market & How Has It Changed Over Time?
- What Is Spending On Income Assistance Programs?
- What Is Spending On Nutrition Assistance Programs?
- What Is Spending On Housing Assistance Programs?
- How Many Consumers Use Social Service Programs?
In a shifting health care landscape where health homes, accountable care organizations, and pay-for-value contracting are taking hold, understanding the “whole person” is increasingly important. And understanding how to help consumers access social service programs that can help improve their health is equally as important.