Impact of In-Hospital Death on Spending for Bereaved Spouses

Objective: To examine how patients’ location of death relates to health care utilization and spending for surviving spouses. Data Sources/Study Setting: Health and Retirement Study (HRS) 2000–2012 linked to the Dartmouth Atlas and Medicare claims data. Study Design: This was an observational study. We matched bereaved spouses whose spouses died in a hospital to those whose spouses died outside the hospital using propensity scores based on decedent and spouse demographic and clinical characteristics, care preferences, and regional practice patterns. Data Collection/Extraction Methods: We identified 1,348 HRS decedents with surviving spouses. We linked HRS data from each dyad with Medicare claims and regional characteristics. Principal Findings: In multivariable models, bereaved spouses of decedents who died in the hospital had $3,106 higher Medicare spending 12 months postdeath (p =.04) compared to those whose spouses died outside a hospital. Those surviving spouses were also significantly more likely to have an ED visit (OR = 1.5; p <.01) and hospital admission (OR = 1.4; p =.02) in the year after their spouse's in-hospital death. Increased Medicare spending for surviving spouses persisted through the 24-month period postdeath ($5,310; p =.02). Conclusions: Bereaved spouses of decedents who died in the hospital had significantly greater Medicare spending and health care utilization themselves after their spouses’ death.