The survey explored physicians’ perspectives on the COVID-19 pandemic and the future of the health care system. A key factor: social determinants of health (SDoH).

The COVID-19 pandemic has exacerbated longstanding SDoH, causing a disproportionate burden on vulnerable communities across the country. The direct impact of SDoH on patient health outcomes has caught the attention of many providers in the health care system, according to the third part of the 2020 Survey of America’s Physicians COVID-19 Impact Edition.

This year, The Physician’s Foundation biennial survey was split into three smaller surveys to reduce additional time constraints on physicians amid the pandemic and ensure data relevance. The first two parts of the survey, which were released in August and September respectively, revealed the impact of COVID-19 on physician practices and their patients as well as physician wellbeing amid the pandemic. Part three of the survey, which was released last month, indicates the direction physicians believe the health system is headed, with a special focus on SDoH.

Here are the key findings from part three of the survey related to SDoH:

  • Nearly 90 percent of the 1,270 physicians surveyed in September rated affordable health insurance as the most important future policy step
  • Almost all physicians (94 percent) indicated that chronic diseases such as diabetes and heart disease will place the strongest demand on the health care system in 2021, followed by conditions worsened by delayed care due to the pandemic
  • Seventy-three percent of physicians indicated that SDoH such as access to healthy food and safe housing will drive demand for health care services in 2021
  • More than half of physicians (67 percent) indicated that 11 percent or more of their patients delay or decline care due to costs while 44 percent said 26 percent or more of their patients delay care for the same reason
  • The majority of physicians (70 percent) agreed that patient problems with access to healthy food and safe housing or other SDoH should be included in the risk scoring formulas that insurance companies use to determine patient complexity
  • More than half of physicians (63 percent) rated reimbursement for addressing SDoH as an important or extremely important policy step, with responses most favorable among younger physicians, female physicians, and employed physicians
  • Forty percent of physicians agreed that socioeconomic factors such as employment, education, income, and family support have a direct impact on health outcomes, followed by behaviors (30 percent), clinical care (20 percent), and environment (10 percent)

While the 2020 survey didn’t report the number of physicians’ patients affected by SDoH, the 2018 Survey of America’s Physicians revealed 57 percent of physicians said all or many of their patients were affected by a SDoH that significantly impacted their health. Only one percent of physicians at the time said none of their patients were impacted by SDoH.

To better equip physicians to address SDoH, The Physicians Foundation recommends including SDoH in quality measures and physician financial incentives in emerging payment models, such as ACOs, medical homes, and bundled payments.

“Despite these trends, the mechanisms physicians have at their disposal to improve patient conditions caused by SDoH are limited,” said survey authors. “Moreover, physicians who do take steps to address SDoH find this work generally goes uncompensated and is burdensome in the context of a health care system that is still designed primarily to treat (and pay for treating) acute illness. As a result, physicians bear the burden when ‘social risk’ is not accounted for in payment models or risk adjustment.”