TY - JOUR
AU - A. R. C. Silverman
AU - P. J. Chung
AU - M. K. Gould
AU - Q. Ngo-Metzger
AU - M. M. Tauali'i
AU - D. M. Mosen
AU - M. C. Duggan
AU - R. S. Nocon
A1 - 
AB - BACKGROUND: While research on health-related social needs (HRSNs) has expanded, important gaps remain in understanding associations between HRSN and healthcare cost, especially across general populations of patients with broad-ranging medical and social needs. OBJECTIVE: To examine the association between HRSN and healthcare cost in a large, diverse, insured population. DESIGN: In this cross-sectional study, we evaluated cost differences between patients with different HRSN levels using survey-weighted multivariable generalized linear models. We examined three alternate model specifications: one that included controls for basic demographics; another adding insurance type, race/ethnicity, and social isolation; and a third adding a diagnosis-based medical risk index called DxCG. Variables added in the latter models were assessed separately due to concern for over-correlations with HRSN. PARTICIPANTS: 10,226 adult survey respondents (23% response rate) from eight states and Washington, D.C. MAIN MEASURES: The primary exposure was patient-reported HRSN, based on survey questions asking about financial strain, food insecurity, housing instability, and transportation difficulties. HRSN was constructed as a three-level variable. The primary outcome was total direct healthcare cost. KEY RESULTS: "Moderate HRSN" was not significantly associated with cost in any model. In the model controlling for patient demographics, costs for patients with "Severe HRSN" were 1.27 (95%CI: 1.00-1.60) times those of patients with "No HRSN." In a model that adjusted for medical risk (DxCG), the relationship between HRSN and cost was not statistically significant. CONCLUSIONS: Relationships between HRSN and healthcare cost may vary by HRSN level. Our mixed findings highlight the complex relationship between medical and social risks, which often have bi-directional causal relationships. If measures of medical risk incidentally capture variation in social risk, then models controlling for medical risk may mask relationships between HRSN and cost. Further studies should investigate the extent to which HRSN may be related to cost, even when controlling for specific patient diagnoses.
AD - Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA. ARSilverman@mednet.ucla.edu.; Department of Internal Medicine, University of California, Los Angeles, Los Angeles, CA, USA. ARSilverman@mednet.ucla.edu.; Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.; Hawaii Permanente Medical Group, Honolulu, HI, USA.; Kaiser Permanente Center for Health Research, Portland, OR, USA.
AN - 40562891
BT - J Gen Intern Med
C5 - Financing & Sustainability
DA - Jun 25
DO - 10.1007/s11606-025-09647-8
DP - NLM
ET - 20250625
JF - J Gen Intern Med
LA - eng
N2 - BACKGROUND: While research on health-related social needs (HRSNs) has expanded, important gaps remain in understanding associations between HRSN and healthcare cost, especially across general populations of patients with broad-ranging medical and social needs. OBJECTIVE: To examine the association between HRSN and healthcare cost in a large, diverse, insured population. DESIGN: In this cross-sectional study, we evaluated cost differences between patients with different HRSN levels using survey-weighted multivariable generalized linear models. We examined three alternate model specifications: one that included controls for basic demographics; another adding insurance type, race/ethnicity, and social isolation; and a third adding a diagnosis-based medical risk index called DxCG. Variables added in the latter models were assessed separately due to concern for over-correlations with HRSN. PARTICIPANTS: 10,226 adult survey respondents (23% response rate) from eight states and Washington, D.C. MAIN MEASURES: The primary exposure was patient-reported HRSN, based on survey questions asking about financial strain, food insecurity, housing instability, and transportation difficulties. HRSN was constructed as a three-level variable. The primary outcome was total direct healthcare cost. KEY RESULTS: "Moderate HRSN" was not significantly associated with cost in any model. In the model controlling for patient demographics, costs for patients with "Severe HRSN" were 1.27 (95%CI: 1.00-1.60) times those of patients with "No HRSN." In a model that adjusted for medical risk (DxCG), the relationship between HRSN and cost was not statistically significant. CONCLUSIONS: Relationships between HRSN and healthcare cost may vary by HRSN level. Our mixed findings highlight the complex relationship between medical and social risks, which often have bi-directional causal relationships. If measures of medical risk incidentally capture variation in social risk, then models controlling for medical risk may mask relationships between HRSN and cost. Further studies should investigate the extent to which HRSN may be related to cost, even when controlling for specific patient diagnoses.
PY - 2025
SN - 0884-8734
ST - Health-Related Social Needs and Total Healthcare Cost: A Cross-Sectional Study in a Large Integrated Health System
T1 - Health-Related Social Needs and Total Healthcare Cost: A Cross-Sectional Study in a Large Integrated Health System
T2 - J Gen Intern Med
TI - Health-Related Social Needs and Total Healthcare Cost: A Cross-Sectional Study in a Large Integrated Health System
U1 - Financing & Sustainability
U3 - 10.1007/s11606-025-09647-8
VO - 0884-8734
Y1 - 2025
ER -