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The burden of health care costs for patients with dementia in the last 5 years of life.

Abstract：

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.

journal_name

Ann Intern Med

journal_title

Annals of internal medicine

authors

Kelley AS,McGarry K,Gorges R,Skinner JS

doi

10.7326/M15-0381

subject

Has Abstract

pub_date

2015-11-17 00:00:00

pages

729-36

issue

eissn

0003-4819

issn

1539-3704

pii

2466364

journal_volume

163

pub_type

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The burden of health care costs for patients with dementia in the last 5 years of life.