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 zero-inflated 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<0.0001), an extra $1,863 in healthcare expenditure per year, or $77.5 billion in additional healthcare expenditure annually nation-wide. Further, food insecurity was associated with significantly greater emergency department visits (Incidence Rate Ratio [IRR] 1.47, 95% Confidence Interval [CI] 1.12 – 1.93), inpatient hospitalizations (IRR 1.47, 95% CI 1.14 – 1.88), and days hospitalized (IRR 1.54, 95% CI 1.06 – 2.24). Across several analytic approaches, we found that SNAP participation was associated with reduced subsequent healthcare expenditures (best estimate: -$1,409; 95% Confidence Interval [CI] -$2,694 to -$125). We conclude that food insecurity is associated with increased healthcare costs and use, and SNAP participation is associated with lower subsequent healthcare expenditures.
Discussion Paper Number
Berkowitz, Seth A.; Seligman, Hilary K.; and Basu, Sanjay, "Impact of Food Insecurity and SNAP Participation on Healthcare Utilization and Expenditures" (2017). University of Kentucky Center for Poverty Research Discussion Paper Series. 103.