Public Health Spending and Medicare Resource Use: A Longitudinal Analysis of U.S. Communities.

objectiveTo examine whether local expenditures for public health activities influence area-level medical spending for Medicare beneficiaries. DATA SOURCES AND

settingSix census surveys of the nation's 2,900 local public health agencies were conducted between 1993 and 2013, linked with contemporaneous information on population demographics, socioeconomic characteristics, and area-level Medicare spending estimates from the Dartmouth Atlas of Health Care. DATA COLLECTION/EXTRACTION: Measures derive from agency survey data and aggregated Medicare claims. STUDY

designA longitudinal cohort design follows the geographic areas served by local public health agencies. Multivariate, fixed-effects, and instrumental-variables regression models estimate how area-level Medicare spending changes in response to shifts in local public health spending, controlling for observed and unmeasured confounders. PRINCIPAL

findingsA 10 percent increase in local public health spending per capita was associated with 0.8 percent reduction in adjusted Medicare expenditures per person after 1 year (p < .01) and a 1.1 percent reduction after 5 years (p < .05). Estimated Medicare spending offsets were larger in communities with higher rates of poverty, lower health insurance coverage, and health professional shortages.

conclusionsExpanded financing for public health activities may provide an effective way of constraining Medicare spending, particularly in low-resource communities.