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

项目总结/摘要 三分之一的低收入美国家庭经历粮食不安全，这增加了多个风险。 健康问题，并与增加的医疗保健支出和利用。补充 营养援助计划（SNAP，以前的“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被残疾人不成比例地使用，他们 对粮食不安全和医疗保健费用上涨的风险和敏感性增加。慢性病患者 疾病对粮食不安全和SNAP福利的变化也特别敏感。由此可见， SNAP政策将影响医疗保健支出和利用，特别是对残疾人 和慢性疾病。这一领域的稀缺文献支持这一命题，但仅包括生态 我们团队的研究和两项横断面研究。这些研究的因果关系推断有限。 我们建议评估SNAP和医疗支出之间的潜在因果关系 和利用率，假设SNAP降低了医疗保健支出和利用率（目标1）， 对残疾人和长期病患者的影响更大（目标2）。我们将2012-2016年 数据来自马萨诸塞州（MA）所有付款人索赔数据库，MA过渡援助部 （在该州运营SNAP），MA医疗补助计划和MA公共卫生部， 产生唯一详细的纵向数据。我们也将为收件人提供深入的SNAP信息 作为支出、利用、残疾、慢性病和受援者和非受援者人口统计数据， 受惠人士我们将利用技术错误，导致449，000个MA SNAP接受家庭中的43，000个 在2014-2015年期间，任意接收错误的终止通知。其中，约三分之一的人从未重新获得过福利， 大约三分之二的人失去了福利，但最终恢复了福利。造成的全部（100%）损失 和恢复福利代表的冲击明显大于5.5%或13.6%的福利变化 以前研究过的水平，对残疾人和慢性病患者的影响可能会放大。我们将 使用具有中断时间序列设计元素的增长曲线模型来评估SNAP的影响 MA医疗补助人群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态如何调节任何此类影响（目标2）。 社会福利计划，如SNAP，影响健康的关键决定因素，但研究其对健康的影响， 保健是新生的。我们的分析将为卫生系统提供信息，因为他们开发了改善结果的方法 通过解决健康的社会决定因素来降低成本，从而与AHRQ的优先事项保持一致， 提高医疗保健负担能力和效率。

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.