Food insecurity linked to greater health care expenditures

Families facing food insecurity had higher health care expenditures than those who were food secure, a recent study showed.

“We know that food insecurity has a negative impact on individual health outcomes,” Deepak Palakshappa, MD, MSHP, an associate professor of general internal medicine at Wake Forest University, said in a press release. “But we need a better understanding of the financial implications on families and health care expenditures.”

Palakshappa and colleagues evaluated data from 14,666 people in 6,621 families that participated in the 2016 and 2017 Medical Expenditure Panel Survey. The nationally representative survey, which collects information from health care providers across the United States, is conducted annually by the Agency for Healthcare Research and Quality.

Of the participants, 10.1% were food insecure.

“We found that food insecurity in 2016 was associated with increased care expenditures in 2017 among families regardless of insurance coverage type,” Palakshappa said in the release.

More specifically, families facing food insecurity had 20% higher total health care expenditures than families that were food secure — a difference of $2,456 every year ($14,625 vs. $12,169).

Although Palakshappa and colleagues did not find a significant association between food insecurity and child health care expenditures, the researchers noted that food insecurity among individual adults in 2016 was connected to higher health care expenditures in 2017 — $6,693 (95% CI, 5,694-7,693) vs. $5,387 (95% CI, 5,148-5,625), with a difference of $1,307 (95% CI, 279 -2,335).

In addition, families that faced food insecurity in 2016 but were food secure in the following year had higher total expenditures in 2017 than families that were food secure in both 2016 and 2017 — $13,622 vs. $12,247, for a difference of $1,375 (95% CI, 538-2,211).

The researchers noted that “food insecurity was not associated with greater subsequent out-of-pocket expenditures but was associated with greater subsequent expenditures across all other health expenditure categories” like ED visits, inpatient visits, outpatient visits and prescription drugs.

The association between food insecurity and higher expenditures was consistent across all family insurance patterns, including the nearly 20% of families with mixed coverage.

“Interventions that address food insecurity in one or more specific family members may ... provide benefits to others in the home,” Palakshappa said in the release. “And there’s a potential financial benefit for insurers to invest in these programs.”

For families that are all covered by the same carrier, insurer-level initiatives might increase each family member's access to food, improve the family’s health and reduce health care expenditures “in a way that unlocks both financial and health benefits,” the researchers wrote.

“More parents are enrolling their children in Medicaid or CHIP instead of their employer-sponsored health insurance because of increased out-of-pocket expenses,” Palakshappa said in the release. “However, the expansion of public subsidies such as the Supplemental Nutrition Assistance Program or child tax credits can alleviate food insecurity.”

The researchers wrote that their findings have “important implications” for both clinical practice and policy.

“From a policy standpoint, there have been growing investments by Medicare, Medicaid, and commercial health insurers in addressing food insecurity as a way to improve health, mitigate avoidable utilization, and reduce health care expenditures,” they wrote. “Examples include more robust screening for food insecurity, referrals to community-based organizations, and the provision of medically tailored meals. Our findings are consistent with the promise of that approach, as we found greater health care spending in families that experienced food insecurity.”

Palakshappa and colleagues concluded with clinical implications, writing that “although this study identified variation in health insurers within families, there may be an analogous challenge for clinical care providers, where a growing number of food insecurity interventions are being conducted.”

Among national pediatric societies, the researchers said there has been a “strong endorsement” for pediatricians to routinely screen for and address food insecurity.

“Although addressing food insecurity at pediatric visits could have important long-term benefits for children, we found ... that short-term return on investment in the form of reduced health care expenditures might not occur,” they wrote. “Improving families’ access to food at a pediatric visit, however, could have important health benefits for other children and adults in the home, and short-term reductions in health care expenditures may occur for adult family members.”

References:

• Families with food insecurity have greater health care expenditures. https://www.newswise.com/articles/families-with-food-insecurity-have-greater-health-care-expenditures?sc=dwhr&xy=10048998. Published Jan. 9, 2023. Accessed Jan 9, 2023.
• Palakshappa D, et al. Health Affairs. 2023;doi 10.1377/hlthaff.2022.00414.