Composite measures of socioeconomic disadvantage, such as the Area Deprivation Index (ADI) and Social Vulnerability Index (SVI), are increasingly used in clinical outcomes and health services research about healthcare spending. These measures, derived from US Census data, have gained traction, with an emerging interest in their integration into alternative payment models for more equitable outcomes.
The association of ADI and SVI with health care spending, including claims-based spending and patient-reported financial barriers to care, has been the subject of recent research. English-language articles and abstracts from databases like PubMed, Web of Science, Embase, and Cochrane were systematically reviewed to understand this association better.
The review comprised 24 articles and abstracts that employed a cross-sectional, case-control, or cohort study design. In 83% of these studies, ADI and SVI were linked to increased healthcare spending. The remaining studies, primarily with smaller sample sizes from single centers, did not observe this association.
Decoding the Cost: How Socioeconomic Indices Drive Up Healthcare Spending
The increase in spending associated with higher ADI or SVI residence ranged from $574 to $1811 for index surgical hospitalizations, $3003 to $24,075 for 30- and 90-day episodes of care, and $3519 for total annual spending for Medicare beneficiaries. Studies that explored the mechanisms behind these findings pointed to postoperative complications, readmission risk, and poor primary care access as healthcare system-related drivers of increased spending.
These findings suggest that ADI and SVI can play crucial roles in understanding healthcare spending drivers. They can also influence the design of payment and care delivery programs that factor in social risk. The higher healthcare spending and poor care access associated with ADI or SVI at the healthcare system level could be opportunities for co-designing interventions with patients from high ADI or SVI areas. This could improve access to high-value health care and enhance health promotion on a broader scale.
Original Article DOI: 10.1001/jamanetworkopen.2023.56121
Original title: Area-Level Socioeconomic Disadvantage and Health Care Spending: A Systematic Review
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