Oronce Carlos Irwin A, Ponce Ninez A, Sarkisian Catherine A, Zimmerman Frederick J, Tsugawa Yusuke
Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90024, United States.
Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90025, United States.
Health Aff Sch. 2025 Jan 10;3(1):qxae181. doi: 10.1093/haschl/qxae181. eCollection 2025 Jan.
Prior research demonstrates that local government spending on social policies, excluding health care, is linked to improved population health. Whether such spending is associated with better access to primary care and reduced acute care utilization remains unclear. In this cross-sectional study, we evaluated the associations between county-level social spending and individual-level health care utilization among low-income Medicare beneficiaries, aged ≥65 years, from 2016 to 2018. We linked claims data to 4 categories of county-level government expenditures from the US Government Finance Database, including (1) public welfare, (2) public transit, (3) housing/community development, and (4) infrastructure-related social services. The main outcomes were annual primary care visit rates, emergency department visits, and preventable hospitalizations. After adjusting for patient and county characteristics, beneficiaries living in counties with higher spending on housing/community development had 11% higher primary care visit rates. Additionally, those living in counties with higher public transit and housing/community development spending experienced 6%-10% lower preventable hospitalization rates. Lower preventable hospitalization rates were especially pronounced among acute conditions. These findings suggest that investments in social services that address the health-related social needs of low-income older adults may be an important factor to consider in population-level efforts to reduce acute care utilization.
先前的研究表明，地方政府在不包括医疗保健在内的社会政策方面的支出与改善人口健康状况有关。此类支出是否与更好地获得初级保健服务以及减少急性护理的使用相关尚不清楚。在这项横断面研究中，我们评估了2016年至2018年期间年龄≥65岁的低收入医疗保险受益人群中县级社会支出与个人层面医疗保健使用之间的关联。我们将索赔数据与美国政府财政数据库中的4类县级政府支出相关联，包括（1）公共福利、（2）公共交通、（3）住房/社区发展以及（4）与基础设施相关的社会服务。主要结果是年度初级保健就诊率、急诊科就诊次数和可预防的住院率。在对患者和县级特征进行调整后，居住在住房/社区发展支出较高县的受益人初级保健就诊率高出11%。此外，居住在公共交通和住房/社区发展支出较高县的人可预防住院率降低了6%-10%。在急性疾病中，较低的可预防住院率尤为明显。这些发现表明，投资于满足低收入老年人与健康相关社会需求的社会服务可能是在人口层面努力减少急性护理使用时需要考虑的一个重要因素。
