A new study suggests that food assistance programs similar to Meals on Wheels not only keep patients out of the hospital but save money as well, Aaron Carroll writes for JAMA Forum.
The findings, Carroll suggests, cast doubt on a controversial claim made last year by Mick Mulvaney, the director of the White House Office of Management and Budget, that community programs such as Meals on Wheels "sound good" but were not "showing any results."
For the study, which was published last month in Health Affairs, researchers tracked more than 750 people who were dually eligible for Medicare and Medicaid and participated in one of two types of meal assistance programs for at least 6 months from 2014 through 2015.
The first program was medically tailored to patients who had specific dietary needs due to chronic conditions such as diabetes or renal insufficiency. The program delivered five days' worth of lunches, dinners, and snacks each week, aligned with any of 17 different diets.
The second program was a nontailored program that delivered five days' worth of lunches and dinners each week—an approach that Carroll writes is similar to that taken by Meals on Wheels.
The researchers compared individuals in both programs to control groups.
After controlling for a number of factors, including age, sex, and ethnicity, the researchers found that participants in both programs were significantly less likely than control groups to be admitted to the hospital, use emergency transportation, or visit the ED.
The researchers also found that the programs were associated with lower medical spending. The tailored program saved about $570 a month in medical costs compared with a control group, while the non-tailored program saved about $156 a month.
Carroll notes that both programs cost less to operate than the savings generated, so both saved money, with the tailored-diet program saving $220 per participant and the non-tailored program saving $10 per participant.
Food insecurity is believed to be associated with over $77 billion in additional health care expenditures every year, Carroll writes. But he notes, as a country, we seem to be "more willing to spend money in the health care system on expensive treatments rather than on prevention." And often, the preventive care we do invest in improves outcomes but "does not save money"—which makes the cost savings generated by food assistance programs especially compelling, Carroll argues.
While Carroll acknowledges that the study was not a "comprehensive cost-effectiveness analysis," he writes that it showed that meal assistance programs "might at worst break even and at best save money," all the while "preventing hospitalizations and [ED] visits, providing home-bound people with human contact, and making sure they get enough to eat" (Carroll, JAMA Forum, 4/25).
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