The Burden of Health Care Costs for Patients With Dementia in the Last 5 Years of Life

TitleThe Burden of Health Care Costs for Patients With Dementia in the Last 5 Years of Life
Publication TypeJournal Article
Year of Publication2015
AuthorsKelley, AS, McGarry, KM, Gorges, RJ, Skinner, JS
JournalAnnals of Internal Medicine
KeywordsHealth Conditions and Status, Healthcare, Medicare/Medicaid/Health Insurance, Public Policy

Background: Common diseases, particularly dementia, have large social costs for the U.S. population. However, less is known about the end-of-life costs of specific diseases and the associated financial risk for individual households. Objective: To examine social costs and financial risks faced by Medicare beneficiaries 5 years before death. Design: Retrospective cohort. Setting: The HRS (Health and Retirement Study). Participants: Medicare fee-for-service beneficiaries, aged 70 years or older, who died between 2005 and 2010 (n = 1702), stratified into 4 groups: persons with a high probability of dementia or those who died because of heart disease, cancer, or other causes. Measurements: Total social costs and their components, including Medicare, Medicaid, private insurance, out-of-pocket spending, and informal care, measured over the last 5 years of life; and out-of-pocket spending as a proportion of household wealth. Results: Average total cost per decedent with dementia ( 287 038) was significantly greater than that of those who died of heart disease ( 175 136), cancer ( 173 383), or other causes ( 197 286) (P 0.001). Although Medicare expenditures were similar across groups, average out-of-pocket spending for patients with dementia ( 61 522) was 81 higher than that for patients without dementia ( 34 068); a similar pattern held for informal care. Out-of-pocket spending for the dementia group (median, 36 919) represented 32 of wealth measured 5 years before death compared with 11 for the nondementia group (P 0.001). This proportion was greater for black persons (84 ), persons with less than a high school education (48 ), and unmarried or widowed women (58 ). Limitation: Imputed Medicaid, private insurance, and informal care costs. Conclusion: Health care expenditures among persons with dementia were substantially larger than those for other diseases, and many of the expenses were uncovered (uninsured). This places a large financial burden on families, and these burdens are particularly pronounced among the demographic groups that are least prepared for financial risk. Primary Funding Source: National Institute on Aging.

Endnote Keywords

Care and treatment/Public Policy/Financial risk/Dementia/Medicare/Palliative care/Health care expenditures

Endnote ID


Citation Key8242
PubMed ID26502320
PubMed Central IDPMC4809412