Dec 12, 2016 - greater than high school diploma), and household income (expressed as a .... The policies used were 1)an
UKCPR University of Kentucky Center for Poverty Research
Discussion Paper Series DP 2017-02 ISSN: 1936-9379
Impact of food insecurity and SNAP participation on healthcare utilization and expenditures Seth A. Berkowitz, MD MPH Division of General Internal Medicine and Diabetes Population Health Research Center Massachusetts General Hospital/Harvard Medical School Hilary K. Seligman, MD MAS Center for Vulnerable Populations, Zuckerberg SF General Hospital University of California San Francisco Sanjay Basu, MD PhD Department of Medicine, Stanford University Center for Primary Care, Harvard Medical School
Preferred citation: Impact of food insecurity and SNAP participation on healthcare utilization and expenditures. (2017). Berkowitz, S., & Seligman, H. K., & Basu, S. University of Kentucky Center for Poverty Research Discussion Paper Series, DP2017-02. Retrieved [Date] from http://www.ukcpr.org/research/discussion-papers. This project was supported with a grant from the University of Kentucky Center for Poverty Research through funding by the U.S. Department of Agriculture, Economic Research Service and the Food and Nutrition Service, Agreement Number 58-5000-3-0066. The opinions and conclusions expressed herein are solely those of the author(s) and should not be construed as representing the opinions or policies of the sponsoring agencies.
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Impact of food insecurity and SNAP participation on healthcare utilization and expenditures
Seth A. Berkowitz, MD MPH Division of General Internal Medicine and Diabetes Population Health Research Center Massachusetts General Hospital/Harvard Medical School Hilary K. Seligman, MD MAS Center for Vulnerable Populations, Zuckerberg SF General Hospital University of California San Francisco Sanjay Basu, MD PhD Department of Medicine, Stanford University Center for Primary Care, Harvard Medical School
This project was supported with a grant from the University of Kentucky Center for Poverty Research through funding by the U.S. Department of Agriculture, Economic Research Service and the Food and Nutrition Service, Agreement Number 58-5000-3-0066. The opinions and conclusions expressed herein are solely those of the author(s) and should not be construed as representing the opinions or policies of the sponsoring agencies. Berkowitz, Seligman, & Basu -- Page 1
Abstract We tested three hypothesis related to food insecurity and the Supplemental Nutrition Assistance Program (SNAP), America’s largest anti-food insecurity program. We
hypothesized that 1)food insecurity would be associated with increased healthcare
expenditures, 2)food insecurity would be associated with increased use of emergency
department and inpatient services, and 3) SNAP participation would be associated with
lower subsequent healthcare expenditures. We used data from the 2011 National Health
Interview Survey linked to the 2012-13 Medical Expenditures Panel Survey. We used zeroinflated negative binomial regression to test the relationship between food insecurity and healthcare cost and use. We evaluated the association between SNAP participation and
healthcare expenditures using generalized linear regression modeling, near/far matching
instrumental variable analysis using state-level variation in SNAP policy as our instrument, and augmented inverse probability weighting. Those with food insecurity had significantly
greater estimated mean annualized healthcare expenditures ($6,072 vs. $4,208, p
