Title | Out-of-pocket spending in the last five years of life. |
Publication Type | Journal Article |
Year of Publication | 2013 |
Authors | Kelley, A, McGarry, K, Fahle, S, Marshall, SM, Du, Q, Skinner, JS |
Journal | J Gen Intern Med |
Volume | 28 |
Issue | 2 |
Pagination | 304-9 |
Date Published | 2013 Feb |
ISSN Number | 1525-1497 |
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 |
Abstract | 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. |
DOI | 10.1007/s11606-012-2199-x |
User Guide Notes | |
Endnote Keywords | Public policy/Medicare/End of life/health expenditures/out of pocket costs |
Endnote ID | 69626 |
Alternate Journal | J Gen Intern Med |
Citation Key | 7752 |
PubMed ID | 22948931 |
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 |