Medical Research: What is the background for this study? What are the main findings?
Dr. Berkowitz: Prior studies had looked the association between single unmet basic material needs and diabetes control, but hadn’t necessarily looked at multiple things people may not be able to afford, which more closely mirrors real-life. Also, prior studies had been done in a ‘pre-Affordable Care Act’ setting, while, by being in Massachusetts, our study was conducted in a setting of near-universal healthcare coverage that is similar to what the rest of the US is moving towards. We found that difficulties meeting basic material needs, such as difficulties affording food, known as food insecurity, and having financial barriers to taking medications, called cost-related medication underuse, are associated with worse diabetes control and increased use of costly health services in diabetes patients, despite near-universal health insurance coverage
Medical Research: What should clinicians and patients take away from your report?
Dr. Berkowitz: Historically, patients come in for office visits or hospitalizations, but the majority of their time, the majority of the time that determines their health, is spent outside the healthcare system. Healthcare systems are increasingly being held accountable for health outcomes, but these outcomes may be determined by situations that most healthcare systems have limited experience in dealing with. This study, and the body of literature on what are sometimes called ‘social determinants of health’ suggest that simply increasing access to healthcare that does not address root causes of illness may be missing a big piece of what patients need to stay healthy and manage their illnesses. Despite insurance coverage, unmet basic needs were common, associated with worse diabetes control, and high use of expensive health services. If we do not try to address these needs specifically, we may make little progress in improving health for vulnerable diabetes patients.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Berkowitz: Because healthcare systems often have little experience in helping patients meet material needs, there is a lot we still don’t know.
First and foremost, we don’t actually know whether helping patients meet material needs will improve their health. We think it should, but this needs to be tested.
Secondly, we need to determine what approaches work best–linking patients with existing community resources, more generous prescription drug coverage, providing nutritious food, etc. Also, we need to know who can do this effectively and efficiently–a community health worker, a resource specialist within a clinic, a case manager?