Dementia and out-of-pocket spending on health care services.

TitleDementia and out-of-pocket spending on health care services.
Publication TypeJournal Article
Year of Publication2013
AuthorsDelavande, A, Hurd, MD, Martorell, P, Langa, KM
JournalAlzheimers Dement
Date Published2013 Jan
ISSN Number1552-5279
KeywordsAged, Dementia, Female, Financing, Personal, Health Expenditures, Humans, Male

BACKGROUND: High levels of out-of-pocket (OOP) spending for health care may lead patients to forego needed services and medications as well as hamper their ability to pay for other essential goods. Because it leads to disability and the loss of independence, dementia may put patients and their families at risk for high OOP spending, especially for long-term care services.

METHODS: We used data from the Aging, Demographics, and Memory Study, a nationally representative subsample (n = 743) of the Health and Retirement Study, to determine whether individuals with dementia had higher self-reported OOP spending compared with those with cognitive impairment without dementia and those with normal cognitive function. We also examined the relationship between dementia and utilization of dental care and prescription medications-two types of health care that are frequently paid for OOP. Multivariate and logistic regression models were used to adjust for the influence of potential confounders.

RESULTS: After controlling for demographics and comorbidities, those with dementia had more than three times the yearly OOP spending compared with those with normal cognition ($8216 for those with dementia vs. $2570 for those with normal cognition, P < .01). Higher OOP spending for those with dementia was mainly driven by greater expenditures on nursing home care (P < .01). Dementia was not associated with the likelihood of visiting the dentist (P = .76) or foregoing prescription medications owing to cost (P = .34).

CONCLUSIONS: Dementia is associated with high levels of OOP spending but not with the use of dental care or foregoing prescription medications, suggesting that excess OOP spending among those with dementia does not "crowd out" spending on these other health care services.


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Endnote Keywords

Out of pocket costs/health Care/Long Term Care/Dementia/dental Care/COMORBIDITY/health care services

Endnote ID


Alternate JournalAlzheimers Dement
Citation Key7914
PubMed ID23154049
PubMed Central IDPMC4019386
Grant ListR01 AG030155 / AG / NIA NIH HHS / United States
U01 AG009740 / AG / NIA NIH HHS / United States
R01AG030155 / AG / NIA NIH HHS / United States