Food Insecurity Is Negatively Associated with Home Health and Out-of-Pocket Expenditures in Older Adults1–3

Abstract

Food insecurity is a persistent, growing, and clinically relevant problem in older adults; however, its effect on healthcare expenditures is not known. This study examined the relationship of food insecurity with Medicare and out-of-pocket expenditures in older Georgians enrolled in Medicare and meal services using 2 complementary datasets: Georgia Advanced Performance Outcomes Measures Project 6 (GA Advanced POMP6) and Medicare claims data in 2008 (n = 903, mean age 76.9 ± 7.8 y, 31.0% male, 64.2% white). Due to the mixed distribution of healthcare expenditure data (e.g., high nonusers, right-skewed distribution for users), 2-part models were used. Approximately one-half of the sample was food insecure (50.4%) and was more likely to report poorer health status and to have chronic diseases than food-insecure individuals. Food-insecure older adults were less likely to have any Medicare expenditure than food-secure older adults. Among those who had positive Medicare expenditure, however, food-insecure and food-secure individuals had similar Medicare expenditures. Food-insecure and food-secure older individuals were equally likely to incur out-of-pocket expenditure. However, among those who had positive out-of-pocket expenditure, food-insecure older individuals had lower out-of-pocket expenditures than their counterparts. Adjusted mean Medicare and out-of-pocket expenditures of food-insecure individuals were $1875 and $310 less than food-secure individuals in 2008, respectively. These findings based on the innovative methodological approaches and datasets suggest complex relationships between food insecurity and healthcare expenditures in older adults, reflecting unique healthcare access and usage patterns.