Total Area Greenness is Associated with Lower Per-Capita Medicare Spending, but Blue Spaces are Associated with Higher Spending

Abstract As evidence continues to mount that areas with more natural spaces also have healthier residents, researchers are beginning to suspect that these benefits extend beyond health to other related factors, such as healthcare spending. If more nature translates to better health, does more nature ultimately reduce the need for and spending on healthcare, and is this especially true for the elderly and disabled, who benefit differently from nature? This study aims to answer that question, employing a cross-sectional, ecological study design on county-level, annual per-capita Medicare spending in the United States. We examine the association between Medicare spending and the amount of total greenness in a county as well as the amount of blue space, or open water, in a county while controlling for demographic, socioeconomic, and healthcare access confounders. Our results show a significant and nonlinear association, that is in many places negative, between greenness and spending and a significant and slightly positive association between blue spaces and spending. These associations persist in varying levels of the urban-rural spectrum, including both the most and least urban counties.