Primary Submission Category: Health care/services
Association Between Governmental Spending on Social Services and Health Care Use Among Low-Income Medicare Beneficiaries
Authors: Carlos Irwin Oronce Ninez Ponce Fred Zimmerman Catherine Sarkisian Yusuke Tsugawa
Presenting Author: Carlos Irwin Oronce*
Background/Significance
Low-income older adults experience a high burden of adverse social risk factors that contribute to worse access to primary care, frequent hospitalizations, and higher mortality. Governmental programs and social services mitigating these risks may lead to better outcomes. This study measured the association between county-level social spending on outcomes of dual-eligible Medicare beneficiaries.
Data/Methods
In this cross-sectional study, we linked claims from Medicare beneficiaries to county-level governmental expenditures data from the US Government Finance Database. Four types of social spending comprised the exposures of interest: per capita spending on (1) public welfare, (2) housing and community development, (3) public transit, and (4) infrastructure. Outcomes included annual rates of primary care visits, emergency department (ED) visits, and preventable hospitalizations (PH). We used separate multivariable Poisson regression models to measure the association between each spending type and beneficiary-level outcome, adjusting for individual and county covariates.
Preliminary Results
607,651 older adults dually-enrolled in Medicaid from 2016 through 2018 residing in 3,121 counties were included. Median county social spending in the four categories was $533 per capita (range: $312 to $1,016). On average, dual-enrollees had 3.5 (SD 3.8) primary care visits, 2.0 (SD 3.5) ED visits, and 0.2 (SD 0.5) preventable hospitalizations per year. After adjustment, higher welfare spending was associated with 16% higher primary care visits (95% CI 5–27%). Higher housing and community development spending was associated with 18% higher primary care visits (95% CI 10-26%), 8% lower PH (95% CI 3-12%), and 12% lower PH from acute conditions (95% CI 5–18%). Higher public transit spending was associated with 6% lower PH (95% CI 3–9%) and 10% lower PH from acute conditions (95% CI 6–15%). Infrastructure spending was not associated with any outcomes.