Social Determinants of Health and Geographic Variation in Medicare per Beneficiary Spending

• DOI: 10.1001/jamanetworkopen.2021.13212
• Publication Date: 2021-06-10T15:21:52Z
• Authors: Yongkang Zhang; Jing Li; Jiani Yu; Robert Tyler Braun; Lawrence P. Casalino
• Keywords: Beneficiary

<h3>Importance</h3> Despite substantial geographic variation in Medicare per beneficiary spending the US, little is known about extent to which social determinants of health (SDoH) are associated with this variation. <h3>Objective</h3> To determine associations between SDoH and county-level price-adjusted spending. <h3>Design, Setting, Participants</h3> This cross-sectional study used data on 2017 fee-for-service (FFS) spending, patient demographic characteristics (eg, age gender) clinical risk score, supply care resources number hospital beds), measures median income unemployment rate) from multiple sources. Multivariable regressions were estimate association across quintiles SDoH. <h3>Main Outcomes Measures</h3> Parts A B beneficiary. included socioeconomic position, race/ethnicity, relationships, residential community context. <h3>Results</h3> Among 3038 counties 33 495 776 FFS beneficiaries (18 352 336 [54.8%] women; mean [SD] age, 72 [1.5] years), for highest quintile was $3785 (95% CI, $3706-$3862) higher, or 49% than bottom-quintile (mean beneficiary, $11 464 [735] vs $7679 [522];<i>P</i> &lt; .001). The total contribution (including through both direct indirect pathways) 37.7% ($1428 $3785) variation, compared 59.8% ($2265 by risk, 14.5% ($549 resources, 19.8% ($751 characteristics. When all factors within same model, 5.8% 4.6% supply, 4.7% characteristics, 62.0% risk. <h3>Conclusions Relevance</h3> These findings suggest considerable proportions Policies addressing disadvantaged patients certain regions have potential contain improve value care; may need be accounted publicly reported physician performance, value-based purchasing incentive programs professionals.