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.

项目概要/摘要 三分之一的低收入美国家庭面临粮食不安全，这增加了多重风险 健康问题，并与医疗保健支出和利用率的增加有关。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 被残疾人使用的比例过高，他们 对粮食不安全和医疗费用增加的暴露和敏感性增加。患有慢性病的人 疾病对粮食不安全和 SNAP 福利的变化也特别敏感。随之而来的是变化 SNAP 政策中的内容将影响医疗保健支出和利用，特别是对于残疾人而言 和慢性疾病。该领域的稀缺文献支持这一主张，但仅包括生态学 我们团队的研究和两项横断面研究。这些研究的因果推论是有限的。 我们建议评估 SNAP 与医疗保健支出之间的潜在因果关系 和利用率，假设 SNAP 减少医疗保健支出和利用率（目标 1）并且 对于残疾人和慢性病患者来说，这种影响更为严重（目标 2）。我们将链接2012-2016 数据来自马萨诸塞州 (MA) 所有付款人索赔数据库、马萨诸塞州过渡援助部 （在该州运营 SNAP）、马萨诸塞州医疗补助计划和马萨诸塞州公共卫生部， 产生独特详细的纵向数据。我们还将为收件人提供深入的 SNAP 信息 作为有关接收者和非接收者的支出、利用率、残疾、慢性病和人口统计数据 收件人。我们将利用导致 449,000 个 MA SNAP 接收家庭中的 43,000 个家庭遭受技术错误的漏洞 2014年至2015年期间任意收到错误终止通知。其中，大约三分之一从未重新获得福利， 大约三分之二的人失去了福利，但最终恢复了福利。由此产生的完全（100%）损失 和福利恢复所带来的冲击明显大于福利变化 5.5% 或 13.6% 先前研究的水平，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 的效果 马萨诸塞州医疗补助人群医疗保健支出和利用模式的终止和恢复 （目标 1），我们将评估残疾和慢性病状况如何调节任何此类影响（目标 2）。 SNAP 等社会福利计划影响健康的关键决定因素，但对其影响的研究 医疗保健才刚刚起步。我们的分析将为卫生系统制定改善结果的方法提供信息 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 提高医疗保健的负担能力和效率。