北卡罗来纳大学Marisa Elena Domino研究组在研究中取得进展。他们的研究报道了北卡罗来纳州健康机会试点项目中的医疗补助支出和与健康相关的社会需求。相关论文于2025年2月27日发表在《美国医学会杂志》上。

重要性:与健康相关的社会需求是健康状况恶化和卫生保健支出增加的驱动因素。在北卡罗来纳州医疗补助计划1115豁免中，健康机会试点（HOP）计划允许非医疗服务解决与健康相关的社会需求，如健康食品盒和住房导航，由医疗补助计划资助，在北卡罗来纳州的三个地区。

目的:确定个人参与HOP计划是否与较低的医疗补助支出有关。

设计、设置和参与者：使用2021年3月至2023年11月的北卡罗来纳州医疗补助数据对中断时间序列进行比较评估。13227名HOP登记者与73469名医疗补助受益人进行了比较，后者报告了与健康相关的社会需求（HOP资格标准），但由于居住县的原因，他们没有资格获得HOP。

暴露 ；参与HOP。

主要成果和措施：主要结果是每个受益人每月在医疗和HOP服务上的医疗补助支出总和。次要结局包括医疗保健使用（急诊科就诊、住院和门诊就诊）。

结果:在13227名HOP和73469名对照组成员中，平均年龄为23.4（SD，18.8）岁，63.9%为女性，42.4%为黑人，57.4%为白人（参与者可以报告>1个种族）。指数前的月平均支出为828美元（标准差，5105美元）。在HOP注册者中，89%的人至少接受过一次HOP服务，85%的服务是食品服务。比较中断时间序列分析估计，在HOP注册当月，支出有所增加（水平变化，687美元；95%置信区间，420-954美元）。然而，与没有HOP的反事实情景相比，HOP参与者的支出趋势差异较小（趋势变化，每个受益人每月85美元；95%CI，122至48美元；P<0.001）。综上所述，这些发现表明，在开始HOP后的第8个月，每月支出相当于估计的反事实支出，此后则更低。HOP参与者的急诊就诊趋势差异较低（每1000人月6人；95%CI，8至4）。住院率（每1000人月1例；95%CI，2至0）或门诊就诊率（每千人月1次；95%CI7至9）没有统计学上的显著差异趋势。

研究结果表明，本研究的结果表明，HOP计划与入学时的支出增加有关，随后支出呈下降趋势。

附：英文原文

Title: Medicaid Spending and Health-Related Social Needs in the North Carolina Healthy Opportunities Pilots Program

Author: Seth A. Berkowitz, Jessica Archibald, Zhitong Yu, Myklynn LaPoint, Salma Ali, Maihan B. Vu, Gaurav Dave, Kori B. Flower, Marisa Elena Domino

Issue&Volume: 2025-02-27

Abstract: Importance  Health-related social needs are drivers of worse health and high health care spending. In North Carolina Medicaid’s 1115 waiver, the Healthy Opportunities Pilots (HOP) program allows for nonmedical services to address health-related social needs, such as healthy food boxes and housing navigation, financed by Medicaid, in 3 regions of North Carolina.

Objective  To determine whether individual participation in the HOP program is associated with lower Medicaid spending.

Design, Setting, and Participants  Comparative interrupted time series evaluation using North Carolina Medicaid data from March 2021 through November 2023. The 13227 HOP enrollees were compared with 73469 Medicaid beneficiaries reporting a health-related social need (a HOP eligibility criterion), but who were ineligible for HOP due to county of residence.

Exposure  Participation in HOP.

Main Outcomes and Measures  The primary outcome was the sum of spending by Medicaid on medical and HOP services per beneficiary per month. Secondary outcomes included health care use (emergency department visits, inpatient admissions, and outpatient visits).

Results  Among 13227 HOP and 73469 comparison group members, the mean age was 23.4 (SD, 18.8) years, 63.9% were female, 42.4% were Black, and 57.4% were White (participants could report >1 race). Mean monthly preindex spending was $828 (SD, $5105). Of HOP enrollees, 89% received at least 1 HOP service, and 85% of services were food services. The comparative interrupted time series analysis estimated that spending increased at the month of HOP enrollment (change in level, $687; 95% CI, $420-$954). However, the trend in spending for HOP participants was differentially lower (change in trend, $85 per beneficiary per month; 95% CI, $122 to $48; P<.001) relative to a counterfactual scenario without HOP. Taken together, these findings indicated that monthly spending was equivalent to estimated counterfactual expenditures by month 8 after starting HOP and lower thereafter. Emergency department visit trend was differentially lower for HOP participants (6 per 1000 person-months; 95% CI, 8 to 4). There was no statistically significant differential trend in hospitalizations (1 per 1000 person-months; 95% CI, 2 to 0) or outpatient visits (1 per 1000 person-months; 95% CI, 7 to 9).

Conclusions and Relevance  Results of this study suggest that the HOP program was associated with increased spending at enrollment, followed by a subsequently lower spending trend.

DOI: 10.1001/jama.2025.1042

Source: https://jamanetwork.com/journals/jama/fullarticle/2830892