The authors of a new study conclude that healthful food prescriptions in Medicare and Medicaid would be more cost-effective after 5 years than preventive drug treatments.

Medicare and Medicaid are the two largest healthcare programs in the US.

Approximately 57 million people received coverage from Medicare plans in 2016, while Medicaid had about 66 million enrollees in 2018.

Medicare is the federal health insurance program that supports certain groups of people, including those who are 65 years or older, those with permanent kidney failure, and some younger people with disabilities.

Medicaid is a federal and state program that helps people who have limited income and resources.

Medicare accounted for 15% of the federal budget in 2017. As the population ages and healthcare costs rise, experts estimate that healthcare spending will continue to grow. According to projections, Medicare spending will reach 18% by 2028.

Encouraging people to eat better

A team of researchers from Tufts University and Brigham and Women's Hospital in Boston, MA analyzed the effects of healthful food prescriptions in Medicare and Medicaid. The study, which the journal PLOS Medicine published, found that offsetting the cost of healthful foods by 30% through health insurance would improve health and reduce costs.

According to the co-first author Dr. Dariush Mozaffarian, dean of the Friedman School of Nutrition Science and Policy at Tufts:

"Medicare and Medicaid are the two largest healthcare programs in the US, together covering one in three Americans and accounting for 1 in every 4 dollars in the entire federal budget."

The researchers modeled two different scenarios that would play out if Medicare and Medicaid covered 30% of healthful food purchases.

In both scenarios, these programs would cover 30% of fruit and vegetable purchases. However, in the second scenario, they would also cover 30% of purchases of whole grains, nuts, seafood, and plant oils.

The findings showed that the first scenario would prevent about 1.93 million cases of heart disease, while the second one would prevent close to 3.28 million cases of heart disease as well as 120,000 cases of diabetes.

The positive effect on diabetes is due to the role that whole grains, nuts, and seeds play in diabetes prevention.

"We found that encouraging people to eat healthy foods in Medicare and Medicaid—healthy food prescriptions—could be as or more cost-effective as other common interventions, such as preventative drug treatments for hypertension or high cholesterol," says Yujin Lee, PhD, a postdoctoral fellow at the Friedman School and co-first author of the study.

Reducing the need for healthcare

Both scenario one and scenario two significantly reduced healthcare utilization, leading to savings of about $40 billion and $100 billion respectively. The total costs for subsidizing just fruits and vegetables were $122.6 billion, while it cost $210.4 billion to cover the broader range of healthful foods.

Comparing the net costs with savings and health benefits, both scenarios were highly cost-effective.

To conduct this study, the researchers used a validated micro-simulation model called CVD Predict that generated samples representative of the Medicare, Medicaid, and dual-eligible populations. To achieve this, they used data from recent National Health and Nutrition Examination Surveys (NHANES), published sources, and meta-analyses.

They then applied the two scenarios to each of the different samples and assessed their effect at 5-, 10-, and 20-year horizons and at a simulated lifetime horizon.

This research forms part of the Food Policy Review and Intervention Cost-Effectiveness (Food-PRICE) research initiative, which is a collaboration of international researchers who are working to improve the health of the US population by identifying possible nutrition strategies and evaluating their cost-effectiveness.

"These new findings support the concept of [the public initiative] Food is Medicine: That innovative programs to encourage and reimburse healthy eating can and should be integrated into the healthcare system."

—Dr. Dariush Mozaffarian

The researchers believe that this study provides the best national assessment of the potential effects that these initiatives could have at the federal level, but they caution that these models cannot prove the health and cost effects of the incentives.