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SNAP reduces health care expenditures in low-income adults
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Low-income adults who participated in the Supplemental Nutrition Assistance Program had lower total health care expenditures than those who did not, according to research published in JAMA Internal Medicine.
“Food insecurity is associated with high health care expenditures, but the effectiveness of food insecurity interventions on health care costs is unknown,” Seth A. Berkowitz, MD, MPH, from the division of general internal medicine at Massachusetts General Hospital, and colleagues wrote.
Berkowitz and colleagues conducted a retrospective cohort study to determine if participation in the Supplemental Nutrition Assistance Program (SNAP), the United States’ largest anti-food insecurity program, reduces subsequent health care expenditures.
The researchers enrolled 4,447 noninstitutionalized adults (2,567 women; mean age, 42.7 years) who had an income 200% below the federal poverty threshold and completed both the 2011 National Health Interview Survey and the 2012 to 2013 Medical Expenditure Panel Survey. A total of 1,889 participants reported participating in SNAP in 2011 and 2,558 did not.
The researchers calculated total health care expenditures, including all paid claims and out-of-pocket costs, between 2012 and 2013. They used generalized linear modeling and adjusted for demographics, socioeconomic factors, census region, health insurance and self-reported medical conditions.
Data showed that SNAP participants were more likely to be younger (mean age, 40.3 vs. 44.1 years), have public insurance or be uninsured (84.9% vs. 67.7%), and be disabled (24.2% vs. 10.6%; P < .001 for all) than other low-income adults. Age- and gender-adjusted models revealed that health care expenditures were similar between those would did and did not participate in SNAP (difference, $34; 95% CI, $1,097 to $1,165).
According to fully adjusted models, participation in SNAP significantly reduced estimated annual health care expenditures by approximately $1,400 per year per person. These results were confirmed in sensitivity analyses.
“Helping to address food insecurity by making SNAP enrollment easier may be an important way to contain health care costs for vulnerable Americans,” Berkowitz and colleagues concluded. – by Alaina Tedesco
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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James Corbett, JD, MDiv
In an environment with value-based payment models, these findings suggest that clinicians have increased financial interest in ensuring that their patients have their basic needs met. While the study concluded that SNAP participation was associated with lower health care costs it did not call out the relationship between SNAP eligibility and access to food as a result of enrollment into the program.
Access and quality of food through the SNAP program should have been included in the self-reported SNAP participation survey so that it could have strengthened the connection between self-management interventions and improved clinical outcomes when chronic diseases are present. When discussing health care costs, access to the type of care that affects those costs should be referenced – it dictates the level of utilization and its impact on the health care system.
On a wider system level, these finding suggest that the health care system has a viable interest in advocating for and developing programs that address social needs that are integrated into the clinical model. The study mentioned how new initiatives, such as the CMS’ Accountable Health Communities program, are looking at social determinants of health and their effects on health care expenditures. It did not reference investments made by health care systems to control utilization stemming for unmet social needs.
This study affirms what we at Centura Health have been working towards with our community-based programming. Our Community Health Workers navigate our patients to community based organizations that address their unmet social needs, including SNAP benefits. These programs have proven immensely successful both financially and from a quality and organization mission perspective. Clinicians might also benefit from doing the SNAP challenge, much like James Corbett, Senior VP of Community Health Improvement and Values Integration at Centura Health, when he highlighted the difficulty of living on SNAP benefits.
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