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

Although there is wide geographic variation in Medicare per beneficiary spending in the U.S., little research has been done about the extent to which social determinants of health (SDoH) are associated with this variation. In a study published in JAMA Network Open, a research team from the Division of Health Policy and Economics sought to better understand this association. Dr. Yongkang Zhang, research associate in population health sciences; Dr. Jing Li, assistant professor of population health sciences; Dr. Jiani Yu, assistant professor of population health sciences; Dr. Robert Tyler Braun, instructor in population health sciences; and Dr. Lawrence Casalino, professor of population health sciences; conducted a cross-sectional study using county-level data on 2017 Medicare fee-for-service (FFS) spending, patient demographic characteristics and clinical risk score, supply of health care resources, and SDoH measures from multiple sources. They found that SDoH were associated with 37.7 percent of variation in price-adjusted Medicare per beneficiary spending between counties in the highest and lowest quintiles of spending in 2017. With these findings, the researchers suggest that policies addressing SDoH for disadvantaged patients in certain regions could have the potential to contain healthcare spending and improve the value of healthcare. They also noted that patient SDoH may need to be accounted for in publicly reported physician performance, as well as in value-based purchasing incentive programs for health care professionals.

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