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- Title
Public Health Spending and Medicare Resource Use: A Longitudinal Analysis of U.S. Communities.
- Authors
Mays, Glen P.; Mamaril, Cezar B.
- Abstract
<bold>Objective: </bold>To examine whether local expenditures for public health activities influence area-level medical spending for Medicare beneficiaries.<bold>Data Sources and Setting: </bold>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.<bold>Data Collection/extraction: </bold>Measures derive from agency survey data and aggregated Medicare claims.<bold>Study Design: </bold>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.<bold>Principal Findings: </bold>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.<bold>Conclusions: </bold>Expanded financing for public health activities may provide an effective way of constraining Medicare spending, particularly in low-resource communities.
- Subjects
UNITED States; MEDICARE; FINANCING of public health; SOCIOECONOMIC factors; MEDICAL economics; MEDICARE beneficiaries; ECONOMIC impact; PUBLIC health &; economics; LOCAL government; LONGITUDINAL method; RESEARCH funding; RETROSPECTIVE studies
- Publication
Health Services Research, 2017, Vol 52, p2357
- ISSN
0017-9124
- Publication type
journal article
- DOI
10.1111/1475-6773.12785