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Food Insecurity, SDOH Costs $2.5K in Family Healthcare Expenditures

Health Affairs data showed the cost of food insecurity and SDOH but indicated that mixed coverage in a single household could complicate intervention investments.

More studies are drawing a link between social determinants of health (SDOH) food insecurity and health outcomes, with the latest in Health Affairs showing that food insecurity yielded some $2,500 in healthcare expenditures for a whole family in one year.

That amounts to about 20 percent higher yearly healthcare expenditures for food insecure families than those families not experiencing food insecurity.

But the data also showed that the around 20 percent of households that have a mixture of health insurance plans and carriers might stymie efforts to mitigate food insecurity, with payers questioning how investments will impact their own member panels.

Food insecurity is a unique social determinant of health because it has a trickle-down effect on the entire family. If one family member is food insecure, it is likely the entire family is food insecure and therefore the whole family may see the impacts on their health.

“Evaluating the relationship between food insecurity and total family health care spending could provide a better understanding of the financial implications of food insecurity for families overall,” the researchers wrote in the study. “This nuanced information is important for understanding the potential impact of food insecurity interventions, which can have spillover effects throughout the family even when targeted to an individual.”

The researchers found that there’s a direct throughline between food insecurity and health outcomes, as measured by healthcare expenditures. Using the Medical Expenditure Survey (MEPS), the researchers looked at 6,600 families and compared those that experienced food insecurity in 2016 and their overall healthcare expenditures in 2017.

The 10 percent of families that were food insecure in 2016 had 20 percent higher family healthcare expenditures in 2017, totaling $2,456 in yearly healthcare costs. That was true for families with any kind of health payer coverage, including public insurance ($1,855 higher costs), private insurance ($2,107 higher costs), no insurance, or a mix of different types of insurance coverage ($3,531 higher costs).

Moreover, food insecurity was linked with higher healthcare expenditures even if the status of food insecurity got better over time, the researchers said. If a family was food insecure in 2016 but not in 2017, they still had higher 2017 expenditures than families that were food secure the whole time. This finding indicates not only that food insecurity can have detrimental impacts on health outcomes and expenditures but also that interventions to remedy food insecurity can stem those costs.

The emphasis on overall family healthcare expenditures, not just the expenditures generated by a single individual, is critical here, the researchers said. Certain social determinants of health, like food insecurity, have trickle-down impacts on the rest of the family; the same could be true of the inverse, that SDOH interventions for an individual could impact the whole household.

“As families generally share food and other resources, an intervention that addresses food insecurity in one or more specific family members may provide benefits to other family members, even if only a single individual qualifies for the benefit,” the researchers posited.

“Thus, for families covered by the same carrier, initiatives at the insurer level could increase every family member’s access to food, improve the health of both children and adults, and reduce family health care expenditures in a way that unlocks both financial and health benefits.”

But that gets complicated when looking at the one in five families with mixed insurance coverage, a phenomenon that often happens because it is less costly for qualifying families to enroll their children in Medicaid/CHIP than the guardians’ employer-sponsored health plans.

That means that one payer implementing a food insecurity intervention might not see the full return on investment because the intervention would benefit some enrolled in a different insurance plan.

“Economic theory would suggest that such externalities could lead to less investment in initiatives than might be socially desirable,” the team theorized.

Public subsidies or using public health agencies to address food insecurity could mitigate that challenge. Expanding SNAP benefits or the child tax credit are two examples of such strategies.

The researchers acknowledged that this trend could be true for clinicians. A pediatric clinic funding medically tailored meals might see that the program benefits adults who do not visit that practice.

“Similar to health insurance level initiatives, there could be an important externality with food insecurity interventions in clinics or health systems, and less investment in these initiatives may occur than socially desirable,” the researchers concluded. “Future studies are needed to evaluate the effect of addressing food insecurity at an individual patient visit on the health outcomes and health care use of other family members.”

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