Insurance as a Social Determinant of Health in Surgery

Social Determinants of Health and Insurance Status

Social determinants of health (SDOH) are conditions in the environment where people are born, live, learn, work, play, worship, and age, that can affect their health, functioning, and quality-of-life outcomes and risks. According to the Office of Disease Prevention and Health Promotion from the US Department of Health and Human Services (DHHS), SDOH can be grouped into five domains: economic stability, education access and quality, neighborhood and built environment, social and community context, and healthcare access and quality. In this chapter, health insurance is discussed as part of the last domain.

In the United States, many people do not get the healthcare services they need. In fact, 1 out of 10 people in the United States do not have health insurance and lack basic access to healthcare services and medications. A lack of primary care provider (PCP), for example, is a reason to not get recommended healthcare services, such as cancer screenings. Health insurance, or lack of it, can significantly influence healthcare outcomes on surgical diseases and surgical care.

Information from the US Census Bureau demonstrated that in 2017, 67.2% of people had private health insurance, 37.7% had government insurance, and 8.8% of people (28.5 million) did not have health insurance at any point during the year. Most recent numbers from the 2020 Census show that in 2021, 66% of people had private health insurance, 35.7% had government insurance, and 8.3% (27.2 million) were uninsured, a 0.5% decrease from 2017 ( Fig. 10.1 ).