TY - JOUR
T1 - The burden of health care costs for patients with dementia in the last 5 years of life
AU - Kelley, Amy S.
AU - McGarry, Kathleen
AU - Gorges, Rebecca
AU - Skinner, Jonathan S.
N1 - Publisher Copyright:
© 2015 American College of Physicians.
PY - 2015/11/17
Y1 - 2015/11/17
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84947466048&partnerID=8YFLogxK
U2 - 10.7326/M15-0381
DO - 10.7326/M15-0381
M3 - Article
C2 - 26502320
AN - SCOPUS:84947466048
SN - 0003-4819
VL - 163
SP - 729
EP - 736
JO - Annals of Internal Medicine
JF - Annals of Internal Medicine
IS - 10
ER -