CONTEXT | As many as 15% of U.S. households with children experience food insecurity. Although the importance of a healthy diet to a child's development and overall well-being is evident, the relationship between food insecurity and healthcare utilization is less clear-cut. Gaining a better understanding of this complex relationship is a timely issue for healthcare organizations that are implementing or considering food-related interventions under value-based care.
STUDY OBJECTIVE | Several studies have found an association between food insecurity and higher healthcare expenditures in adults, but this association is not as well established in children. The current study addresses that gap.
THE DETAILS | Researchers analyzed a nationally representative sample of 7,959 children who participated in the 2016 Medical Expenditure Panel Survey. They examined the relationship between household responses to food-security questions, healthcare expenditures (both self-reported and collected from providers), and a range of healthcare utilization and quality measures.
FINDINGS | Children were more likely to live in a food-insecure household if they were African-American or Hispanic, had Medicaid or CHIP insurance, or had special health care needs. After adjusting for these and other factors, children from food-insecure households had slightly higher odds of visiting the emergency department (ED) or a primary-care physician during the year. They were also more likely to miss school due to illness, and their caregivers had more difficulty accessing care when needed. However, there was no statistically significant association between food insecurity and inpatient hospitalizations, specialist visits, or overall healthcare expenditures.
PULL QUOTE | "[W]hen measuring the efficacy of food security-based interventions within the context of health care delivery, we suggest that improvement targets be set toward observed disparities, including improving access and/or availability of care, reducing ED use, and enabling school attendance. Still, additional research is needed to determine if these disparities are amenable to delivery system intervention or are caused by more systemic effects of poverty and social disadvantage."
SO WHAT? | The link between food insecurity and healthcare utilization observed in adults was not borne out here. This finding may reflect lower utilization among children in general, or it may be that the health effects of food insecurity in children take longer than a year to manifest. It may even reflect the (unmeasured) influence of the support services provided to low-income children by schools, community organizations, and state agencies. The apparent differences between children and adults deserve further exploration and may have implications for how health systems and policymakers join together to address food insecurity and manage healthcare costs.
Source. Peltz A and Garg A. (2019). Food Insecurity and Health Care Use. Pediatrics.