“Population health.” A term co-opted by hospitals describing the efforts they are taking to improve the health of the community.
The approach is aligned with what hospitals know – clinical care. We are simply further medicalizing things. Instead of illness in the body, the “chief complaint” is a shifting payor mix that hurts executives pocket books, the “diagnosis” is government regulations, and the “treatment” is a population health approach that reduces ER readmissions.
Hospitals have already begin to screen for (see ACEs), diagnose, and ‘treat’ the social determinants. Vast sums of money are being spent on collecting patient data on items such as poverty, social distress, and educational access. Data are then used to “screen” for the presence of social needs. A positive screen triggers a referral to a social service agency, assuming one exists. It is assumed that the visit to the social service agency addresses and resolves the social need. Several models are being highlighted (Health Leads, Camden Coalition, Health Begins, etc.)
It’s possible this might work, I want to be open to it. But right now I am skeptical, mainly because it’s using the same model (individualized medical care) to treat a very different problem (systemic social ills).
And even if this model did work, most people, even most people in non-profits, aren’t trying to work themselves out of a job. Why would they?? To expect them to is not realistic.
Incentives are not aligned! This is why I believe in government. Government, especially democratic government, is about the social contract. We agree not to commit anarchy, if the government provides basic social services that meet our basic human rights and allow us life, liberty, and the pursuit of happiness. If most people agree on these basic principles, we can collect a modest amount of taxes to pay for those basic human rights. With these basic needs mets met, we cure (alleviate) 99% of social ills – petty crime, gangs, violence, drugs, joblessness, ignorance, illiteracy, polluted air and water, etc.
Millenials want people to do things because it is the right thing to do. They want hospital executives to invest in community health because they should, even if that means less money for the health system. <– in full disclosure, that’s me. I want that. I want nonprofit hospital execs to say – “y’know. I am making $2 mil a year. Maybe it’s time for me to take a payout, operate this company on slimmer margins, and work toward making myself obsolete.” What’s the worst that could happen? People get healthier, the hospital shrinks to providing critical care services, and many people lose their jobs.
But when in human history has that actually happened? I heard several people complaining that the (Republican) Governor of Georgia only veto’d a religious freedom/anti-LGBTQ bill because of economic forces driving him to do it. Well, so what? Do they actually expect him to change his values? Or to not care about his base? Or to completely write off the funders who were backing him?
People do things because it is in their best interest. (I wonder if my 21 year old self would agree with me.) To expect something else is a clear indication that the speaker/author is of privilege, such that survival is not the most pressing issue.