Integrating Social and Medical Care: Could it Worsen Health and Increase Inequity?

Abstract As a result of a large and compelling body of evidence documenting the impacts of social determinants, such as income and education, on health outcomes, health care systems are beginning to incorporate social and economic risk data into health care delivery decisions. But there is a risk that some of these efforts could worsen health and widen health inequities. We highlight 3 examples—including recent policy changes in Medicaid, social needs, informed risk prediction models, and advances in precision medicine—where the inclusion of social risk information threatens to reduce care quality or health care access for some groups of patients. A new dialog is needed about both the opportunities and potential consequences of bringing information about patients' social circumstances into a market-based health care system.