Public Health and Social Services Expenditures Lead to Reductions - - PowerPoint PPT Presentation

Public Health and Social Services Expenditures Lead to Reductions in Preventable Admission Rates

Kevin Curwick, BA

• J. Mac McCullough, PhD, MPH

Arizona State University

Financial Disclosures

• The authors do not have any financial

relationships to disclose.

Background

• Focus on the contribution

that “social services” have

• n health outcomes
• Social services contribute

to individuals’ ability to access health-supportive services

Source: McGinnis JM, Williams-Russo P, Knichman

• JR. The case for more active policy attention to health
• promotion. Health Aff (Millwood) 2002, 21(2):78-93.

Background

• Previously established links between spending and

health outcomes

– Premature death – Overall mortality rate – Disease-specific death rates

• Limits of current research:

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Research Objective

• To identify the influence of local public

health and social services spending on avoidable hospitalizations.

Theoretical Model and Hypothesis

• Hypothesis: Increases in local governmental

spending for public and other relevant social services would result in better social services (quality or quantity) available to the community, reducing the need for ambulatory care (quantity or quality) and avoidable hospitalizations.

$$$

SDoH

Unnecessary hospitalization Ambulatory care need

Methods: Data Sources

County Public Spending

2007 – 2009 data for all 80,000+ local governments

• n social services*

Avoidable Hospitalizations

2011 – 2013 data for 1,264 counties Measures hospitalizations for a composite of 12 conditions for which access to high quality primary care could have avoided (e.g., uncontrolled diabetes or HTN, asthma, dehydration, etc.) *Available as Census every 5 years, we obtained a special-use version with annual estimates for 80%+ of the

• population. We used linear nearest neighbor interpolation for individual missing estimates.

County Socioeconomic Data

Median household income, unemployment, uninsurance, population size and demographics, etc.

Hospital Community Health Service Provision

2012 data on number of community health services (community outreach, education initiatives, health fairs, etc.) offered by hospitals in each county

Types of Spending Examined

Social Services

– Fire & Ambulance Services – Housing & Community Development – Libraries – Natural Resources – Parks & Recreation – Protective Inspections – Public Welfare – Sewerage – Transportation – Waste Management

Education

– K-12 education – Higher education

Health

– Public Hospitals – Public Health and Community Healthcare

Methods: Analytic Models

• Simplified Model Structure:

PQI (year 5) =

Change from Baseline Spending for: Health, Social Services, and Education (year 1) + County Sociodemographic Factors (year 5) + Health Factors (year 2) + Baseline Spending for Health, Social Services, & Edu

• xtmixed regression using Stata 15

– County and year fixed effects – State random effects

Results

• 32 states reported

PQI data (50 states reported spending)

• Counties (n = 1,264)

spend an average of $508 on health, $910

• n social services,

and $1,975 on education

• Yellow =

more/healthier

• Red = less/sicker

Average PQI Fifth Qunitile Fourth Quintile Third Quintile Second Quintile First Quintile

PQI

Spending

*Above charts use a 2011- 2013 average for visual representation

Results

After controlling for baseline spending: $10 per capita increase from average spending amount (5 years) 1.8 – 2.2 preventable hospitalizations avoided per 100,000 population

Discussion

• Additional spending for social services associated

with reductions in preventable hospitalizations

– Even after controlling for other spending, community resources, baseline health factors, and other county characteristics

• Hospitalizations for acute conditions seem to be more

sensitive to spending within a 5-year period

• More social service spending is associated with a

reduced need for ambulatory care (quantity or quality) and avoidable hospitalizations, which is a leading indicator for overall health outcomes of a community.

Thank you! Questions?

kcurwick@asu.edu