Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, Box 1070, New York, NY 10029, USA.
J Gen Intern Med. 2013 Feb;28(2):304-9. doi: 10.1007/s11606-012-2199-x. Epub 2012 Sep 5.
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.
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.
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 (n = 3,209).
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.
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.
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.
医疗保险计划的一个主要目标是降低因自付医疗支出而导致经济灾难的风险。然而，对于老年人在生命末期面临的自付医疗支出所带来的累积经济风险，人们知之甚少。
我们使用具有全国代表性的健康与退休研究（HRS）队列，对过去 5 年生命中医疗保险受益人的总自付医疗支出进行回顾性分析。
我们确定了 2002 年至 2008 年之间的 HRS 死亡者；使用每个受试者的死亡日期定义了 5 年的研究期；并排除了在该期间开始时没有医疗保险覆盖的人（n=3209）。
我们检查了生命最后 5 年的总自付医疗支出以及支出占基线家庭资产的百分比。然后，我们根据婚姻状况和死因对结果进行分层。所有测量均根据 2008 年的美元进行了通胀调整。
在死亡前的 5 年中，个人的平均自付支出为 38688 美元（95%置信区间为 36868 美元，40508 美元），夫妻一方死亡的夫妇为 51030 美元（95%置信区间为 47649 美元，54412 美元）。支出高度偏斜，中位数和第 90 百分位数分别为个人 22885 美元和 89106 美元，夫妻分别为 39759 美元和 94823 美元。总体而言，25%的受试者支出超过了基线家庭资产总额，43%的受试者支出超过了非住房资产。在由配偶赡养的人中，有 10%的人超过了总基线资产，有 24%的人超过了非住房资产。按死因划分，平均支出范围从胃肠道疾病的 31069 美元到阿尔茨海默病的 66155 美元不等。
尽管有医疗保险覆盖，但老年人在生命末期仍面临自付医疗支出带来的巨大财务风险。这种风险因疾病而异，使人们难以预测或规划生命最后 5 年的健康相关支出。
