|Title||Out-of-pocket spending in the last five years of life.|
|Publication Type||Journal Article|
|Year of Publication||2013|
|Authors||Kelley, AS, McGarry, K, Fahle, S, Marshall, SM, Du, Q, Skinner, JS|
|Journal||J Gen Intern Med|
|Date Published||2013 Feb|
|Keywords||Aged, Cause of Death, Female, Health Expenditures, Health Services for the Aged, Humans, Male, Marital Status, Medicare, Retrospective Studies, Socioeconomic factors, Terminal Care, United States|
BACKGROUND: A key objective of the Medicare program is to reduce risk of financial catastrophe due to out-of-pocket healthcare expenditures. Yet little is known about cumulative financial risks arising from out-of-pocket healthcare expenditures faced by older adults, particularly near the end of life.
DESIGN: Using the nationally representative Health and Retirement Study (HRS) cohort, we conducted retrospective analyses of Medicare beneficiaries' total out-of-pocket healthcare expenditures over the last 5 years of life.
PARTICIPANTS: We identified HRS decedents between 2002 and 2008; defined a 5 year study period using each subject's date of death; and excluded those without Medicare coverage at the beginning of this period (n = 3,209).
MAIN MEASURES: We examined total out-of-pocket healthcare expenditures in the last 5 years of life and expenditures as a percentage of baseline household assets. We then stratified results by marital status and cause of death. All measurements were adjusted for inflation to 2008 US dollars.
RESULTS: Average out-of-pocket expenditures in the 5 years prior to death were $38,688 (95 % Confidence Interval $36,868, $40,508) for individuals, and $51,030 (95 % CI $47,649, $54,412) for couples in which one spouse dies. Spending was highly skewed, with the median and 90th percentile equal to $22,885 and $89,106, respectively, for individuals, and $39,759 and $94,823, respectively, for couples. Overall, 25 % of subjects' expenditures exceeded baseline total household assets, and 43 % of subjects' spending surpassed their non-housing assets. Among those survived by a spouse, 10 % exceeded total baseline assets and 24 % exceeded non-housing assets. By cause of death, average spending ranged from $31,069 for gastrointestinal disease to $66,155 for Alzheimer's disease.
CONCLUSION: Despite Medicare coverage, elderly households face considerable financial risk from out-of-pocket healthcare expenses at the end of life. Disease-related differences in this risk complicate efforts to anticipate or plan for health-related expenditures in the last 5 years of life.
|User Guide Notes|
|Endnote Keywords|| |
Public policy/Medicare/End of life/health expenditures/out of pocket costs
|Endnote ID|| |
|Alternate Journal||J Gen Intern Med|
|PubMed Central ID||PMC3614143|
|Grant List||P30 AG028741 / AG / NIA NIH HHS / United States |
1P30AG28741-01 / AG / NIA NIH HHS / United States
K23 AG040774 / AG / NIA NIH HHS / United States
U01 AG009740 / AG / NIA NIH HHS / United States
R24 HD041022 / HD / NICHD NIH HHS / United States
T32 AG033533 / AG / NIA NIH HHS / United States
P01 AG019783 / AG / NIA NIH HHS / United States
P01-AG19783 / AG / NIA NIH HHS / United States
1 T32-AG033533 / AG / NIA NIH HHS / United States