“Food is medicine”: Healthy food prescriptions could boost health outcomes in the US, study finds

20 Mar 2019 --- Health insurance coverage to offset the cost of healthy food for US Medicare and/or Medicaid participants would be highly cost-effective after five years and improve health outcomes. This is according to a study, published in PLOS Medicine, whereby a team of researchers modeled the health and economic effects of healthy food prescriptions in the US insurance programs. The significant health outcomes measured, such as a reduction in cardiovascular disease (CVD) cases, could be as or more effective than other common interventions, such as preventative drug treatments for hypertension or high cholesterol, say the researchers.

“Medicare and Medicaid are the two largest healthcare programs in the US, together covering one in three Americans and accounting for one in every four dollars in the entire federal budget,” says co-author Dr. Dariush Mozaffarian, Dean of the Friedman School.

“These new findings support the concept of food is medicine: That innovative programs to encourage and reimburse healthy eating can and should be integrated into the healthcare system,” he continued.

The study estimated the economic and health benefits that would accrue if 30 percent of the cost of healthy food purchases in supermarkets and grocery stores were covered through Medicare and Medicaid, through an electronic debit card. Two scenarios were modeled: 30 percent coverage of fruit and vegetable purchases; and 30 percent coverage of purchases of fruits, vegetables, whole grains, nuts/seeds, seafood and plant-based oils.

The model estimated that both of these programs would improve health and lower healthcare utilization. Over a lifetime of current beneficiaries, the fruit and vegetable incentive would prevent 1.93 million CVD cases; while the broader healthy food incentive would prevent 3.28 million CVD cases and 120,000 diabetes cases. (Only the latter incentive was predicted to reduce diabetes cases because of the role that whole grains and nuts/seeds have in diabetes prevention, notes the study).

Both the fruit and vegetable incentive and the broader healthy food incentive were estimated to reduce healthcare utilization, with savings of US$39.7 billion and US$100.2 billion, respectively. Total food subsidy and other policy costs were US$122.6 billion for the fruit and vegetable incentive and US$210.4 billion for the broader healthy food incentive. Considering net costs vs. savings and health benefits, both programs were highly cost-effective, with incremental costs of US$18,184 per quality-adjusted-life-year (QALY) gained for the fruit and vegetable incentive, and US$13,194 per QALY gained for the healthy food incentive, the study found.

“Our findings support implementation and evaluation of healthy food prescriptions within healthcare systems to improve the diet and health of Americans,” said co-senior author Dr. Renata Micha, Research Associate professor at the Friedman School.

“Healthy food prescriptions are increasingly being considered in private health insurance programs, and the new 2018 Farm Bill includes a US$25 million Produce Prescription Program to further evaluate this approach,” says co-first author Yujin Lee, Ph.D., Postdoctoral Fellow at the Friedman School of Nutrition Science and Policy at Tufts.

A validated micro-simulation model (CVD Predict) generated samples representative of the Medicare, Medicaid and dual-eligible populations. The model utilized national data from the three most recent National Health and Nutrition Examination Surveys (NHANES 2009-2014), as well as data from published sources and meta-analyses, which included demographics, dietary intakes, policy effects, diet-disease effects, policy costs and healthcare costs. The two intervention scenarios were applied to each of the three samples and assessed the impact at five, ten, and 20-year horizons and a simulated lifetime horizon.

This study is part of the Food Policy Review and Intervention Cost-Effectiveness (Food-PRICE) research initiative, a collaboration of researchers working to identify cost-effective nutrition strategies to improve health in the US.

The researchers caution that the study cannot prove the health and cost effects of the incentives modeled. The study is intended to provide the best available national estimates of potential impacts that can be considered at the federal level when designing and evaluating incentive programs.