Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.
College of Health Solutions, Arizona State University, Phoenix, Arizona, USA.
Popul Health Manag. 2022 Apr;25(2):192-198. doi: 10.1089/pop.2021.0294.
Greater investment in the social determinants of health (SDOH) is positively associated with improved health outcomes of both individuals and their communities, which in turn may help to bend the health care cost curve and reduce health care spending. The purpose of this study was to examine the relationship between local governments' spending on the SDOH and the health care costs of privately insured nonelderly adults. Annual spending by local governments on the SDOH for the years 2007-2017 was obtained from the Census of Governments. Annual health care costs for privately insured nonelderly adults for the years 2013-2017 was obtained from the Health Care Cost Institute. Bivariate and multivariate regression analyses were performed to examine the association between county-level local governments' per capita spending on the SDOH and the per member health care costs of privately insured adults living in these counties controlling for community characteristics. All analyses were conducted in 2021. For near-elderly adults ages 55-64, health care costs were significantly higher in counties with the lowest levels of local governmental spending on the SDOH. For adults ages 18-54, in contrast, health care costs were unrelated to local governmental spending. Investments of local governments in the SDOH may have rather limited potential to yield meaningful savings in health care costs for privately insured nonelderly adults at the population level, especially once such investments exceed a minimum threshold.
更多地投资于健康的社会决定因素（SDOH）与个人及其社区的健康结果的改善呈正相关，这反过来又可能有助于降低医疗保健成本曲线并减少医疗保健支出。本研究的目的是检验地方政府在 SDOH 上的支出与私人保险的非老年成年人的医疗保健成本之间的关系。从政府普查中获得了 2007-2017 年地方政府在 SDOH 上的年度支出。从医疗保健成本研究所获得了 2013-2017 年私人保险的非老年成年人的年度医疗保健成本。进行了双变量和多变量回归分析，以检验县级地方政府在 SDOH 上的人均支出与居住在这些县的私人保险成年人的人均医疗保健成本之间的关联，同时控制社区特征。所有分析均于 2021 年进行。对于接近老年的成年人（55-64 岁），在地方政府在 SDOH 上的支出水平最低的县，医疗保健成本明显更高。相比之下，对于 18-54 岁的成年人，医疗保健成本与地方政府支出无关。地方政府对 SDOH 的投资可能在降低私人保险的非老年成年人的整体医疗保健成本方面的潜力相当有限，尤其是一旦此类投资超过最低门槛。
