Major Payers Spent Less Than 1% of 2021 Income on Social Determinants of Health

The share of their income that major payers spend on social determinants of health may have increased over time, but it remains a lackluster percentage, a study published in the Journal of General Internal Medicine found.

The researchers used the 2021 Market Share Report by the National Association of Insurance Commissioners (NAIC) to assess how the top 20 payers with the most market share invested in social determinants of health along with their net incomes. Data spanned 2017 through 2021.

The researchers social spending categories into six categories, which vaguely overlapped with the five social determinants of health domains, along with a seventh “general social determinants of health” category for unspecified spending. When payers did not provide a breakdown of spending by category, the researchers distributed the funds evenly between the categories that the payers named.

The six categories were: education, employment, food security, housing, social and community context, and transportation. The researchers did not include investments in care for community health workers, domestic violence, mental health, natural disasters, substance use, technological infrastructure, or racial equity initiatives that did not specifically address social determinants of health.

The researchers acknowledged that this method could lead to some inaccuracies, particularly due to the potential that investments are misclassified and that there may have been some public postings by payers about social determinants of health investments that the researchers missed.

“Trends in social spending by top 20 private health insurers from 2017 to 2021 show that housing programs disproportionately received the most funding, followed by food security and general SDoH programs. Trends also show that funding for nearly all categories peaked in 2020, likely due to the onset of the COVID-19 pandemic,” the study explained.

The top 20 payers combined spent at least $1.87 billion on social determinants of health from 2017 through 2021. The top six payers contributed almost three-quarters of that amount.

The top six payers’ average contributions as a percentage of their incomes grew between 2017 and 2021. They started by investing an average of 0.11 percent of their income on social determinants of health in 2017 and by 2021 this rose to 0.67 percent. In the middle, the percent of their income spiked dramatically in 2020, rising to 1.6 percent.

Housing was the biggest area for investment. Payers invested $1.2 billion in housing as a social determinant of health during the study’s timeframe.

Food security was another big area of social determinants of health spending. The top 20 payers put a total of at least $238 million toward food security programs between 2017 and the end of 2021.

Social and community context, education, and employment trailed far behind the first- and second-place investment areas. Payers put $58.6 into employment, $57.2 million into education, and $49.7 million into social and community context supports.

Transportation received the least amount of funds according to the Market Share Report data. Payers invested $13.4 million into transportation efforts.

Another $247 million went toward general, uncategorized social determinants of health initiatives.

While payer investments in social determinants of health are commendable, they are not significant contributions in light of payers’ overall income, the study stressed. At the same time, the argument could be made that these dollars are better used in lowering members’ out-of-pocket healthcare spending, including premiums.