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Impact of Social Determinants of Health (SDoH) on Healthcare Utilization and Access

Background

The Society of Actuaries Research Institute (SOA) would like to better understand the relationship between social determinants of health (SDoH), access to healthcare, and healthcare utilization. Previous SOA research https://www.soa.org/resources/research-reports/2025/sdoh-medicaid-risk-adjustment/ has shown counterintuitive findings where higher levels of certain SDoH, such as education or housing stability, have been associated with lower observed healthcare costs. These findings suggest that access to care may play a key role in interpreting the relationship between SDoH and utilization.

Research Purpose and Objective

The purpose of this research is to examine how incorporating access to healthcare as an explicit factor refines understanding of the impact of SDoH on healthcare utilization. The SOA seeks to advance knowledge of how SDoH and access interact, which could improve approaches to risk adjustment. The following are examples of proposed topics that may be addressed:

  • Investigate how the inclusion of access to healthcare as a variable modifies the observed relationship between SDoH and healthcare utilization.

  • Assess methodological approaches to defining and measuring access to healthcare, recognizing potential limitations in claims data.

  • Explore how various SDoH factors interact with access to influence utilization, without limiting the research to predefined SDoH variables or specific markets.

  • Identify implications for risk adjustment, potential financial impacts, and healthcare delivery.

Proposals are encouraged to, if feasible, include a comprehensive set of SDoH variables that will be reflected in the study, rely on individual-level (not aggregate) data, and incorporate robust, quantitative measures of provider availability and accessibility.

Expected Deliverables

  • A comprehensive research report detailing methods, findings, and implications.

  • An executive summary that communicates findings for both technical and non-technical audiences.

  • Clear definition of the study’s approach or approaches to measuring access to healthcare in future research and practice.

  • An outline of data requirements, including considerations for individual-level and community-level SDoH variables.

  • A discussion of the potential practical implications for healthcare organizations and payers.

Note that the list above is not meant to be exhaustive; different or additional topics may also be considered.

Proposal Requirements

To facilitate the evaluation of proposals, the following information should be submitted:

  • Resumes of the researcher(s), including any graduate student(s) expected to participate, indicating how their background, education and experience bear on their qualifications to undertake the research. If more than one researcher is involved, a single individual should be designated as the lead researcher and primary contact. The person submitting the proposal must be authorized to speak on behalf of all the researchers as well as for the firm or institution on whose behalf the proposal is submitted.

  • An outline of the approach to be used (e.g. literature search, model, etc.), emphasizing issues that require special consideration. Details should include the data source(s) and techniques to be used, collateral material to be consulted, and possible limitations of the analysis.

  • A description of the expected deliverables and any supporting data, tools or other resources.

  • Cost estimates for the research, including computer time, salaries, report preparation, material costs, etc. Such estimates can be in the form of hourly rates, but in such cases, time estimates should also be included. Any guarantees as to total cost should be given and will be considered in the evaluation of the proposal. While cost will be a factor in the evaluation of the proposal, it will not necessarily be the decisive factor.

Please note that as a policy, the SOA Research Institute generally does not provide funding to cover academic institution overhead expenses.

As a guide for developing the project budget, please review the Historical Project Cost Guide (see Appendix)

  • A schedule for completion of the research, identifying key dates or time frames for research completion and report submissions. The SOA is interested in completing this project in a timely manner. Suggestions in the proposal for ensuring timely delivery, such as fee adjustments, are encouraged.

  • Other related factors that give evidence of a proposer's capabilities to perform in a superior fashion should be detailed.

Selection Process

The SOA will appoint a Project Oversight Group (POG) to oversee the project. The POG is responsible for recommending the proposal to be funded. Input from other knowledgeable individuals also may be sought, but the POG will make the final recommendation, subject to SOA leadership approval. An SOA staff research actuary will provide staff actuarial support.

Questions

Any questions regarding this RFP should be directed to Research-DEI@soa.org with the subject line “ Impact of Social Determinants of Health (SDoH) on Healthcare Utilization and Access”.

Notification of Intent to Submit Proposal

If you intend to submit a proposal, please email written notification by [November 14, 2025] to Research-DEI@soa.org with the subject line “Impact of Social Determinants of Health (SDoH) on Healthcare Utilization and Access (DEI131)”.

Submission of Proposal

Please email your proposal to Research-DEI@soa.org with the subject line “Impact of Social Determinants of Health (SDoH) on Healthcare Utilization and Access (DEI131)”; proposals must be received no later than December 5, 2025. It is anticipated that all proposers will be informed of the status of their proposal by the end January 2026.

Conditions

The selection of a proposal is conditioned upon and not considered final until a Letter of Agreement is executed by both the Society of Actuaries Research Institute and the researcher.

The SOA reserves the right to not award a contract for this research. Reasons for not awarding a contract could include, but are not limited to, a lack of acceptable proposals or a finding that insufficient funds are available. The SOA also reserves the right to redirect the project as is deemed advisable.

The SOA plans to hold the copyright to the research and to publish the results with appropriate credit given to the researcher(s).

The SOA may choose to seek public exposure or media attention for the research. By submitting a proposal, you agree to cooperate with the [Society of Actuaries/sponsoring entity] in publicizing or promoting the research and responding to media requests.

The SOA may also choose to market and promote the research to members, candidates and other interested parties. You agree to perform promotional communication requested by the SOA, which may include, but is not limited to, leading a webcast on the research, presenting the research at an SOA meeting, and/or writing an article on the research for an SOA newsletter.

Conflict of Interest

You agree to disclose any of your material business, financial and organizational interests and affiliations which are or may be construed to be reasonably related to the interest, activities and programs of the SOA.

Appendix

The cost ranges below are intended as a guide for budgeting project costs for proposals in response to SOA Research Institute Request for Proposals (RFP). Please note these figures span the 33rd to 66th percentiles for all projects as well as projects that involve a specific approach (lit review, survey, etc.). They are based on historical costs over several recent years. Expected costs for some RFPs may fall outside these ranges depending on the nature of the work and resources required for completion.

All Contracted Projects

This category includes all contracted projects that the Institute has undertaken within the last several years.

The 33rd-66th percentile project costs range is $25,000 - $50,000.

Literature Reviews

This category includes projects that involved only a literature review or the cost for the portion of a larger project that included a literature review.

The 33rd-66th percentile project costs range is $15,000 - $20,000.

Surveys

This category includes all projects that had a survey as their primary component.

The 33rd-66th percentile project costs range is $28,000 - $55,000.