Impact of Neighborhood Social and Environmental Resources on Medicaid Spending.
Impact of Neighborhood Social and Environmental Resources on Medicaid Spending.
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社区社会和环境资源对医疗补助支出的影响。
DOI：
10.1016/j.amepre.2021.02.019
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发表时间：
2021
影响因子：
5.5
通讯作者：
Wolff,JenniferL
中科院分区：
文献类型：
--
作者：
Sherry,MelissaK;Bishai,DavidM;Padula,WilliamV;Weiner,JonathanP;Szanton,SarahL;Wolff,JenniferL
在一个新冠肺炎、黑人生命重要和不可持续的医疗支出的时代，迫切需要努力解决健康的根本原因。将医疗支出与社区资源变化联系起来的研究，对于为社会状况提供更多资金的理由至关重要。然而，很少有研究将社区因素与医疗支出联系起来。这项研究评估了社区、社会和环境资源与整个支出分布中的医疗支出之间的关系。方法从2016年居住在马里兰州巴尔的摩的医疗补助参与者样本中提取个人健康结果。建立了邻里社会和环境资源的多维指数，并按三分位数(高、中、低)进行分层。在未调整和调整的两部分模型和分位数回归模型中，研究了与居住在高、中、低资源社区相关的个人水平医疗支出的差异。结果即使在控制了年龄、种族、性别和发病率之后，生活在社会和环境资源低的社区的参保者在平均和跨医疗费用分配上的支出也明显高于生活在社会和环境资源高的社区的参保者。平均而言，低资源社区和高资源社区的个人支出差异估计为每人每年523.60美元。结论居住在低资源社区(与高资源社区相比)的居民在医疗支出分布上与较高的个人水平医疗支出相关。研究结果表明，除了解决个人行为和风险的传统取向外，努力解决社区的社会和环境背景也有潜在的好处。
IntroductionIn an era of COVID-19, Black Lives Matter, and unsustainable healthcare spending, efforts to address the root causes of health are urgently needed. Research linking medical spending to variation in neighborhood resources is critical to building the case for increased funding for social conditions. However, few studies link neighborhood factors to medical spending. This study assesses the relationship between neighborhood social and environmental resources and medical spending across the spending distribution.MethodsIndividual-level health outcomes were drawn from a sample of Medicaid enrollees living in Baltimore, Maryland during 2016. A multidimensional index of neighborhood social and environmental resources was created and stratified by tertile (high, medium, and low). Differences were examined in individual-level medical spending associated with living in high-, medium-, or low-resource neighborhoods in unadjusted and adjusted 2-part models and quantile regression models. Analyses were conducted in 2019.ResultsEnrollees who live in neighborhoods with low social and environmental resources incur significantly higher spending at the mean and across the distribution of medical spending even after controlling for age, race, sex, and morbidity than those who live in neighborhoods with high social and environmental resources. On average, this spending difference between individuals in low- and those in high-resource neighborhoods is estimated to be $523.60 per person per year.ConclusionsLiving in neighborhoods with low (versus those with high) resources is associated with higher individual-level medical spending across the distribution of medical spending. Findings suggest potential benefits from efforts to address the social and environmental context of neighborhoods in addition to the traditional orientation to addressing individual behavior and risk.