Public Health Spending and Medicare Resource Use: A Longitudinal Analysis of U.S. Communities.
Health Serv Res
; 52 Suppl 2: 2357-2377, 2017 12.
Article
in En
| MEDLINE
| ID: mdl-29130263
ABSTRACT
OBJECTIVE:
To examine whether local expenditures for public health activities influence area-level medical spending for Medicare beneficiaries. DATA SOURCES ANDSETTING:
Six census surveys of the nation's 2,900 local public health agencies were conducted between 1993 and 2013, linked with contemporaneous information on population demographics, socioeconomic characteristics, and area-level Medicare spending estimates from the Dartmouth Atlas of Health Care. DATA COLLECTION/EXTRACTION Measures derive from agency survey data and aggregated Medicare claims. STUDYDESIGN:
A longitudinal cohort design follows the geographic areas served by local public health agencies. Multivariate, fixed-effects, and instrumental-variables regression models estimate how area-level Medicare spending changes in response to shifts in local public health spending, controlling for observed and unmeasured confounders. PRINCIPALFINDINGS:
A 10 percent increase in local public health spending per capita was associated with 0.8 percent reduction in adjusted Medicare expenditures per person after 1 year (p < .01) and a 1.1 percent reduction after 5 years (p < .05). Estimated Medicare spending offsets were larger in communities with higher rates of poverty, lower health insurance coverage, and health professional shortages.CONCLUSIONS:
Expanded financing for public health activities may provide an effective way of constraining Medicare spending, particularly in low-resource communities.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Public Health
/
Medicare
/
Local Government
Type of study:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Aspects:
Determinantes_sociais_saude
/
Equity_inequality
Limits:
Humans
Country/Region as subject:
America do norte
Language:
En
Journal:
Health Serv Res
Year:
2017
Document type:
Article