To evaluate interventions that address drivers of health, look beyond ROI

We are in an exciting era of health care innovation, especially when it comes to addressing drivers of health such as food insecurity, housing instability, and transportation barriers (also called health-related social needs [HRSN]). For example, innovative programs might provide food subsidies or medically tailored meals to address the barrier to heathy eating that food insecurity represents, or provide housing to combat the health harms of homelessness.

The growth of such innovations raises an important question: What tools should policy makers use to evaluate these interventions’ likely impact? When making decisions about how to allocate finite resources, a common approach is to use return on investment (ROI) analysis. This has led to the rise of ROI calculators, for example, meant to help guide health care payers and health care producers in their decision making.

With this article, however, I argue that ROI makes little sense as a metric to guide decision making about health interventions. This is because the objective of health interventions is to improve health, but ROI analysis excludes almost all health benefits from consideration. Instead, if economic evaluation is thought valuable to guide decision making, there are better options, such as cost-benefit or cost-effectiveness analyses, which consider a fuller range of impacts.