TY - JOUR T1 - Out-of-pocket spending in the last five years of life. JF - J Gen Intern Med Y1 - 2013 A1 - Amy Kelley A1 - Kathleen McGarry A1 - Sean Fahle A1 - Samuel M Marshall A1 - Qingling Du A1 - Jonathan S Skinner KW - Aged KW - Cause of Death KW - Female KW - Health Expenditures KW - Health Services for the Aged KW - Humans KW - Male KW - Marital Status KW - Medicare KW - Retrospective Studies KW - Socioeconomic factors KW - Terminal Care KW - United States AB -

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 (nā€‰=ā€‰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.

PB - 28 VL - 28 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22948931?dopt=Abstract U2 - PMC3614143 U4 - Public policy/Medicare/End of life/health expenditures/out of pocket costs ER - TY - RPRT T1 - The Risk of Out-of-Pocket Health Care Expenditure at End of Life Y1 - 2010 A1 - Samuel M Marshall A1 - Kathleen McGarry A1 - Jonathan S Skinner KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Net Worth and Assets AB - There is conflicting evidence on the importance of out-of-pocket medical expenditures as a risk to financial security, particularly at older ages. We revisit this question, focusing on health care spending near the end of life using data from the Health and Retirement Study for the years 1998-2006. We address difficulties with missing values for various categories of expenditures, outliers, and variations across individuals in the length of the reporting period. Spending in the last year of life is estimated to be 11,618 on average, with the 90th percentile equal to 29,335, the 95th percentile 49,907, and the 99th equal to 94,310. These spending measures represent a substantial fraction of liquid wealth for decedents. Total out-of-pocket expenditures are strongly positively related to wealth and weakly related to income. We find evidence for a mechanism by which wealth could plausibly buy health: large expenditures on home modifications, helpers, home health care, and higher-quality nursing homes, which have been shown elsewhere to improve longevity. JF - NBER Working Paper PB - National Bureau of Economic Research CY - Cambridge, MA U4 - health care costs/demographics/education/wealth/Longevity ER -