Capitol Correspondence - 01.21.20

Big Picture: Learning from Existing Single Payer, Social Determinants of Health Models

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In a continued effort to keep readers informed of larger discussions in the healthcare space that may eventually carry over to Medicaid or disability supports, we are sharing two articles on trending topics: single-payer models and efforts to consider social determinants of health.

Vox feature on Taiwan’s popular single-payer model… and its resulting doctor shortage:

“In the 1990s, Taiwan did what has long been considered impossible in the US: The island of 24 million people took a fractured and inequitable health care system and transformed it into something as close to Sen. Bernie Sanders’s vision of Medicare-for-all as anything in the world.


Taiwan made its choice in the 1990s and embraced single-payer. It has required sacrifice: by doctors who believe they’re forced to see too many patients every day; by patients with complex and costly conditions who can’t always access the latest treatments; by citizens who have been asked from time to time, and will be asked again, to pay more for their health care than they did before.


Taiwanese people take advantage of their cheap, accessible health care. The average number of physician visits per year (12.1) is nearly twice that of other developed economies. There was a dramatic spike in use after single-payer was passed: A 1997 JAMA research paper led by Shou-Hsia Cheng found that physician visits among the newly insured doubled in the first year of the program compared to the year before. That has had predictable downsides: Hospitals get crowded in Taiwan. The capacity of health care providers to attend to everyone in need can be stretched pretty thin.”


Politico Pro article on Camden Coalition (ties into social determinants of health):

“TRENTON, N.J. — The Camden Coalition of Healthcare Providers has drawn rave reviews for its oft-replicated strategy of using hospital data to develop personalized interventions for high-risk patients, connecting people with complex medical histories to primary care physicians and social services.

But a new report published in the New England Journal of Medicine casts doubt on the program’s effectiveness in achieving one of its core goals — bringing down health care costs by reducing patients’ reliance on emergency rooms.


The typical Camden Coalition patient has a complicated medical history, often coupled with mental health or addiction, and frequently has unsteady access to the staples of a stable home life, such as housing, employment, transportation and food.

[Dr. Jeffrey] Brenner [founder of the Camden Coalition] found that individualized care — which often incorporated home visits — along with better access to social services helped bring down the frequency of his patients’ trips to the emergency room. Early results were promising: The coalition’s first 36 patients saw a 40 percent reduction in their hospital visits.

Those successes soon led cities like Trenton and Newark to follow suit. Brenner, who now works on population health projects for UnitedHealth, helped cities like Kansas City and San Diego develop similar programs.

But even as the coalition’s reach expanded beyond Camden, core elements of its strategy were beginning to shift, Noonan said.

The interventions offered in 2014 and 2015 tended to focus on traditional health care and social services — the coalition was particularly effective in enrolling patients in the Supplemental Nutrition Assistance Program, according to the study. Subsequent pilot programs emphasize housing, employment and wrap-around services as well.


Access to care was also a problem, Noonan said. Primary care physicians in Camden lacked the bandwidth to take on new patients — 40 percent of the patients in the study didn’t see a provider until more than two weeks after they were discharged, according to the study. The coalition has since launched a ‘7-Day Pledge’ initiative designed to assure enrolled patients receive a primary care visit within a week of their discharge.”