Effects of the Supplemental Nutrition Assistance Program on healthcare costs and utilization

补充营养援助计划对医疗保健成本和利用的影响

• 批准号: 10091587
• 负责人: Rajan Anthony Sonik
• 金额: $ 3.77万
• 依托单位: ALTAMED HEALTH SERVICES CORPORATION
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2022-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10091587
• 关键词: Effects; Supplemental; Nutrition; Assistance; Program

Project Summary/Abstract A third of low-income US households experience food insecurity, which increases the risk for multiple health problems and is associated with increased healthcare expenditures and utilization. The Supplemental Nutrition Assistance Program (SNAP, formerly the “Food Stamp Program”) has been shown to reduce (but not eliminate) food insecurity. Notably, SNAP is disproportionately utilized by people with disabilities, who have heightened exposure and sensitivity to food insecurity and elevated healthcare costs. People with chronic illnesses are also especially sensitive to food insecurity and changes in SNAP benefits. It follows that changes in SNAP policies would affect healthcare expenditures and utilization, particularly for people with disabilities and chronic illnesses. The scarce literature in this area supports this proposition but only consists of ecological studies by our team and two cross-sectional studies. Causal inferences from these studies were limited. We propose to assess the potential causal relationships between SNAP and healthcare expenditures and utilization, hypothesizing that SNAP reduces healthcare expenditures and utilization (Aim 1) and that such effects are heightened for people with disabilities and chronic illnesses (Aim 2). We will link 2012-2016 data from the Massachusetts (MA) All-Payer Claims Database, the MA Department of Transitional Assistance (which operates SNAP in the state), the MA Medicaid program, and the MA Department of Public Health, yielding uniquely detailed longitudinal data. We will have in-depth SNAP information for recipients, as well as data on expenditures, utilization, disability, chronic conditions, and demographics for recipients and non- recipients. We will exploit technical errors that led to 43,000 out of 449,000 MA SNAP-recipient households arbitrarily receiving wrongful termination notices in 2014-2015. Of these, about a third never regained benefits, and about two-thirds lost benefits but eventually had them reinstated. The resulting complete (100%) losses and reinstatements of benefits represent significantly larger shocks than the 5.5% or 13.6% changes in benefit levels studied previously, with effects likely magnified for people with disabilities and chronic illnesses. We will use growth curve models with interrupted time series design elements to assess the effects of the SNAP terminations and reinstatements on healthcare spending and utilization patterns in the MA Medicaid population (Aim 1), and we will assess how disability and chronic illness status moderated any such effects (Aim 2). Social welfare programs such as SNAP affect key determinants of health, but study of their effects on healthcare is nascent. Our analyses will inform health systems as they develop methods to improve outcomes and reduce costs by addressing the social determinants of health, thereby aligning with AHRQ’s priority to improve health care affordability and efficiency.

项目摘要/摘要 三分之一的低收入美国家庭经历粮食不安全，这增加了多重的风险 健康问题，与医疗保健支出增加和利用有关。补充 营养援助计划（SNAP，以前是“食品券计划”）已被证明可以减少（但不是 消除）粮食不安全。值得注意的是，SNAP被残疾人的使用不成比例 对粮食不安全和医疗保健成本提高的暴露和敏感性提高。患有慢性的人 疾病也对粮食不安全和捕获益处的变化特别敏感。随之而来的是变化 在快照政策中，将影响医疗保健支出和利用，特别是对于残疾人 和慢性病。该领域的稀缺文献支持该提议，但仅由生态组成 我们的团队和两个横断面研究的研究。这些研究的因果推断受到限制。 我们建议评估快照与医疗保健支出之间的潜在因果关系 以及利用，假设的捕捉可以减少医疗支出和利用率（AIM 1） 残疾患者和慢性病患者增强了这种影响（AIM 2）。我们将链接2012-2016 马萨诸塞州（MA）全付款人索赔数据库的数据，MA过渡援助部 （在该州运营SNAP），MA Medicaid计划和MA公共卫生部， 产生独特的详细纵向数据。我们还将为收件人提供深入的快照信息 作为有关接受者的支出，利用，残疾，慢性病和人口统计的数据 收件人。我们将利用技术错误，导致449,000 MA Snap-Recipient家庭中有43,000个 2014 - 2015年任意收到错误的终止通知。其中，大约三分之一从未保留过好处， 大约三分之二的人失去了好处，但最终使他们恢复了好处。产生的完成（100％）损失 福利的恢复代表的冲击明显大于5.5％或13.6％的福利变化 以前研究的水平有可能对残疾人和慢性病患者进行影响。我们将 使用带有时间序列设计元素的增长曲线模型来评估快照的效果 MA医疗补助人口中医疗保健支出和利用模式的终止和恢复 （AIM 1），我们将评估残疾和慢性疾病状况如何调节任何此类影响（AIM 2）。 SNAP等社会福利计划会影响健康的关键决定者，但研究了它们对 医疗保健是新生的。我们的分析将为卫生系统开发改善结果的方法提供信息 并通过解决健康的社会决定者来降低成本，从而使AHRQ的优先事项保持一致 提高医疗保健负担能力和效率。