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Member Research and Reports

Member Research and Reports

Kentucky: Can Expanded Public Health Funding Curb Medicare Expenditures?

A new study by University of Kentucky College of Public Health investigators examines whether local expenditures for public health activities influence area-level medical spending for Medicare beneficiaries. The resulting publication appears in Health Services Research.   Its authors are Dr. Glen P. Mays, F. Douglas Scutchfield Endowed Professor in Health Services and Systems Research and Dr. Cezar B. Mamaril, research assistant professor, both in the department of health management and policy at Kentucky.

[Photos: Dr. Cezar B. Mamaril (left) and Dr. Glen P. Mays]

Investigators drew data from six census surveys of the nation’s 2,900 local public health agencies, which were conducted between 1993 and 2013, and linked the data with contemporaneous information on population demographics, socioeconomic characteristics, and area-level Medicare spending estimates from the Dartmouth Atlas of Health Care. Measures derived from agency survey data and aggregated Medicare claims.

A longitudinal cohort design followed 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.

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

The authors conclude that expanded financing for public health activities may provide an effective way of constraining Medicare spending, particularly in low-resource communities.