This month we will be looking at a few topics in healthcare economics that were brought to my attention as areas of particular interest by one of our learners. First, we will consider how access to voting is a social determinant of health and how voting policies that exclude minorities, those with disabilities, and low-income groups negatively impact social determinants of health for these already marginalized groups. In 2022, the American Medical Association passed a policy resolution declaring that voting is a social determinant of health. Is there a place in ED’s to offer voter registration?  Our second topic for discussion will address the issue of “superusers” of the healthcare system and how to best manage individuals with complex health and social needs who generally utilize a disproportionate percentage of ED resources  Programs such as the Camden Coalition featured in a New Yorker article by Atul Gawande provides excellent insight into these efforts despite mixed data regarding efficacy.

Stanicki B, et al. Expanding voter registration to clinical settings to improve health equity. Health Serv Res. 2023 Oct;58(5):970-975. Epub 2023 Aug 14. PMID: 37580058; Appraisal

 Grade MM, et al The Healthy Democracy Kit: design, implementation, uptake, and impact of a novel voter registration toolkit for healthcare settings. BMC Public Health. 2023 May 26;23(1):962. doi: 10.1186/s12889-023-15800-x. PMID: 37237346; Appraisal

Finkelstein A, et al. Health Care Hotspotting - A Randomized, Controlled Trial. N Engl J Med. 2020 Jan 9;382(2):152-162. doi: 10.1056/NEJMsa1906848. PMID: 31914242; Appraisal