Carlos Irwin A. Oronce

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 study, authors 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. Authors linked claims data to 4 categories of county-level government expenditures from the U.S. 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.

Findings: 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.
 

As value-based payment models incorporate both measures of health equity and low-value care (LVC), understanding how LVC varies by race is vital for interventions. Authors measured racial differences in LVC in a contemporary sample.

They analyzed claims from adults ≥ 55 years receiving care at five academic medical centers in California from 2019 to 2021. This sample included patients who received a service that could be classified as LVC. The primary outcome was whether a service was classified as LVC. Secondary outcomes included clinical categories of LVC (preventive screening, diagnostic testing, prescription drugs, and preoperative testing).

Findings: Among 15,720 members who received potentially LVC, non-Hispanic white older adults comprised 59% of the sample, followed by Asian (17%), unknown race (8%), Latino (8%), non-Hispanic Black (5%), and other race (2%). Asian, Black, and Latino older adults were less likely to receive LVC compared to white older adults, specifically preventive and preoperative services. Asian, Black, and Latino older adults, however, were more likely to receive low-value prescriptions.

These diverging racial patterns in LVC across different measures likely reflect differential mechanisms, underscoring the need to use clinically specific measures rather than composite measures, which obscure underlying heterogeneity and could lead to potentially harmful and inequity-producing interventions.