Widow(er) Poverty and Out-of-Pocket Medical Expenditures Near the End of Life

Objectives. Elderly widows are three times as likely to live in poverty as older married people. This study investigates the gap in poverty, income, and wealth between these groups. Focus is placed on the role played by out-of-pocket medical expenditures spent on dying spouses. Methods. A national panel survey of people age 70 and older in 1993 was used. Income, poverty, wealth, and out-of-pocket expenditures were examined before and after widowhood, with comparisons made with couples not experiencing a death. Results. Forty-four percent of the difference in economic status between widow(er)s and married elderly persons was due to disparities in economic status that existed prior to widowhood. The remaining 56 was due to factors more directly related to the death of a spouse, including the loss of income and expenses associated with dying. On average, out-of-pocket medical expenditures in the final 2 years of life were equal to 30 of the couple's annual income. For couples in the bottom quarter of the income distribution, these expenditures were 70 of their income. Discussion. As policy makers continue to debate expansions and reforms of Medicare, the potential effects of these reforms on economic well-being, particularly among widows, should be considered. Despite the overwhelming success and popularity of programs such as Social Security and Medicare, some subgroups of the elderly population continue to face substantial risks of living in poverty. Whereas the poverty rate for elderly individuals is now hovering at 10 , the poverty rate for elderly widows is nearly twice as high. When examining poverty rates for women in particular, one finds that approximately 5 of married elderly persons are poor compared with 17 of widows (Figure 1). Although policy makers have repeatedly expressed concern about these high rates and enacted legislation attempting to improve the well-being of surviving spouses, the figure demonstrates that this gap has stubbornly remained (see endnote 1). Obviously, the more that is known about the causes and characteristics of poverty among widows, the better targeted public policy can be.

Widowhood/Poverty/income/Wealth

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