Association between governmental spending on social services and health care use among low-income older adults

Prior research demonstrates that local government spending on social policies, excluding health care, is linked to improved population health. Whether such spending is associated with better access to primary care and reduced acute care utilization remains unclear. In this cross-sectional study, we evaluated the associations between county-level social spending and individual-level health care utilization among low-income Medicare beneficiaries, aged ≥65 years, from 2016 to 2018. We linked claims data to 4 categories of county-level government expenditures from the US Government Finance Database, including (1) public welfare, (2) public transit, (3) housing/community development, and (4) infrastructure-related social services. The main outcomes were annual primary care visit rates, emergency department visits, and preventable hospitalizations. After adjusting for patient and county characteristics, beneficiaries living in counties with higher spending on housing/community development had 11% higher primary care visit rates. Additionally, those living in counties with higher public transit and housing/community development spending experienced 6%-10% lower preventable hospitalization rates. Lower preventable hospitalization rates were especially pronounced among acute conditions. These findings suggest that investments in social services that address the health-related social needs of low-income older adults may be an important factor to consider in population-level efforts to reduce acute care utilization.