Stearns S, Edward N, Wang H, Stearns SC; AcademyHealth. Meeting (2003 : Nashville, Tenn.).

Abstr AcademyHealth Meet. 2003; 20: abstract no. 385.

University of North Carolina at Chapel Hill, Health Policy and Administration, 1104C McGavran-Greenberg, CB 7411, Chapel Hill, NC 27599-7411 Tel. (919) 843-2590 Fax (919) 966-6961

RESEARCH OBJECTIVE: This paper assesses the ways in which health insurance for the elderly is not complete, especially for the oldest-old. Despite good insurance for inpatient and outpatient care, Medicare insurance is lacking for other kinds of health care. Two of these, nursing home care and pharmaceuticals, are well documented. But other factors, such as the degree to which burden increases with age, the extent to which out-of-pocket expenditures exceed income, and the level for other services are largely unexplored. STUDY DESIGN: This study uses a longitudinal cohort of Medicare beneficiaries to show how out-of-pocket expenditures increase with age for elderly Americans. It starts by documenting the expenditure-age relationship for total health care expenditures, and then breaks out expenditures by type of service, by insurance coverage, as a fraction of total health care expenditures, and as a fraction of income. POPULATION STUDIED: Graphical and multivariate analysis are conducted on a data file of 24,636 persons aged 65 to 95 from the 1992-1998 Medicare Current Beneficiary Survey Cost and Use files. PRINCIPAL FINDINGS: Out-of-pocket health care expenditures increase substantially with age primarily because of lack of insurance on long-term care. Spending on prescription drugs falls with age after age 80 due to increased use of institutional care. Spending on physicians and suppliers is about the same as prescription drugs, and is higher for persons over age 85. CONCLUSIONS: The study has three main conclusions. First, out-of-pocket expenditures rise with age, and the average monthly out-of-pocket health care expenditures often exceed income after age 85. Second, for persons over age 85, at least three-quarters of out-of-pocket expenditures are spent on long-term care; in contrast, out-of-pocket expenditures for other services are nearly constant or declining with age. Third, out-of-pocket expenditures on prescription drugs are small in comparison to long-term care, and are roughly the same as for physicians and suppliers IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: The results have implications for the debate on Medicare prescription drug coverage, savings over the life cycle, and future Medicare health care expenditures. More attention to the level of out-of-pocket expenditures for physicians and suppliers may be appropriate, and questions such as the extent to which it is feasible or desirable to establish more complete insurance markets need to be addressed.

Publication Types:

• Meeting Abstracts

Keywords:

• Aged
• Costs and Cost Analysis
• Health Expenditures
• Humans
• Income
• Insurance Coverage
• Long-Term Care
• Medicare
• Nursing Homes
• Prescriptions, Drug
• economics
• hsrmtgs

Other ID:

• GWHSR0003684

UI: 102275363

From Meeting Abstracts