住居券の受領と,その後の病院利用と支出との関連
Craig Evan Pollack1,2,3, Amanda L Blackford4, Shawn Du5
1Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
JAMA
|December 4, 2019
まとめ
住居券は成人の病院利用に 顕著な影響を及ぼさなかったが 子供の頃の住居券の受領は 入院と支出の減少と関連していた. これは貧困地域への早期接触が 長期的な健康に与える恩恵を 強調しています
科学分野:
- 公衆衛生
- 医療サービス研究
- 都市研究
背景:
- 近所の貧困は健康の社会的決定因子として認められていますが,それを医療利用と結びつける経験的証拠は限られています.
- 以前の研究はしばしば観察データに依存し,実験デザインによって提供される因果的推論が欠けている.
- 住居政策が健康に与える影響を理解することは 公衆衛生の介入にとって極めて重要です
研究 の 目的:
- 高度な貧困地域への露出を減らす住宅政策と長期間の病院使用との関連を調査する.
- 住所での入院と医療費の差異を 分析する
主な方法:
- ランダム化制御試験の"公正な住宅のための機会への移行"の調査分析
- 4604世帯をランダムに割り当て, 伝統的なバウチャー,または低貧困の近所のバウチャーグループ.
- 長期 (11-21年) のフォローアップのために,すべての支払者による退院とメディケイドの記録をリンクした参加者データ.
主要な成果:
- 住居券を受け取った成人は,対照群と比較して入院率,日数,または支出で有意な違いを示さなかった.
- 住居券を受け取った子供たちは 長期的には 病院入院率がかなり低く 病院入院費も減りました
- 病院での入院日数では,クーポンを受け取った子供では大きな違いは見られませんでした.
結論:
- 住居券は 大人の病院利用に 大きく影響しませんが 子どもの健康に 長期的な効果があることが示されています
- 住居支援による低貧困地区への早期接触は,医療利用の減少と関連しています.
- 地域社会を分散させる住居政策は 特に子供たちの健康に 永続的な影響を与える可能性があることが 示唆されています
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