Department of Geriatrics and Palliative Medicine, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, Box 1070, One Gustave Levy Place, New York, NY, 10029, USA.
Department of Health Law, Policy and Management, Boston VA Healthcare System, Boston University School of Public Health, 150 S. Huntington Ave, Boston, MA, 02130, USA.
Pharmacoeconomics. 2019 Apr;37(4):585-596. doi: 10.1007/s40273-019-00787-4.
While bereavement is associated with increased mortality, it is unclear how bereaved families utilize the healthcare system after the death of their loved ones.
The aim of this study was to examine the association between bereavement and healthcare expenditures for surviving spouses.
We used data from the Health and Retirement Study, a nationally representative cohort study of older adults linked to Medicare claims. We determined a spouse's total Medicare expenditures 2 years before and after their partner's death across six biennial interview waves. Using coarsened exact matching, we created a comparison group of non-bereaved dyads. Costs were wage index- and inflation-adjusted to 2017 dollars. We used generalized linear models and difference-in-differences (DID) analysis to calculate the average marginal effects of bereavement on Medicare spending by gender. We also examined subgroup differences based on caregiver status, cause of death, and length of terminal illness.
Our sample consisted of 941 bereaved dyads and a comparison group of 8899 matched dyads. Surviving female spouses (68% of the sample) had a $3500 increase in spending 2 years after death (p < 0.05). Using DID analyses, bereavement was associated with a $625 quarterly increase in Medicare expenditures over 2 years for women. There was no significant increase in post-death spending for male bereaved surviving spouses. Results were consistent for spouses who survived at least 2 years after the death of their spouse (70% of the sample) CONCLUSIONS: Bereavement is associated with increased healthcare spending for women regardless of their caregiving status, the cause of death, or length of terminal illness. Further study is required to examine why men and women have different patterns of healthcare spending relative to the death of their spouses.
丧亲与死亡率增加有关，但尚不清楚丧亲家庭在亲人去世后如何利用医疗保健系统。
本研究旨在探讨丧亲与健在配偶医疗保健支出之间的关系。
我们使用了来自健康与退休研究的数据，这是一项对老年人的全国代表性队列研究，与医疗保险索赔相关联。我们确定了配偶在其伴侣去世前后 2 年的医疗保险总支出，跨越了六个两年期的访谈波次。使用粗化精确匹配，我们创建了一个无丧亲的配对对照组。成本根据工资指数和通货膨胀进行了调整，以适应 2017 年的美元。我们使用广义线性模型和差异（DID）分析来计算性别对医疗保险支出的丧亲平均边际效应。我们还根据护理人员状况、死因和终末期疾病的长短检查了亚组差异。
我们的样本包括 941 对丧亲的夫妇和一个 8899 对配对的对照组。健在的女性配偶（样本的 68%）在死亡后 2 年内的支出增加了 3500 美元（p<0.05）。使用 DID 分析，女性丧亲后 2 年内医疗保险支出每季度增加 625 美元。健在的男性丧亲配偶在死亡后没有显著增加医疗支出。对于至少在配偶去世后存活 2 年的配偶，结果是一致的（样本的 70%）。
无论其护理状况、死因或终末期疾病的长短如何，丧亲都与女性的医疗保健支出增加有关。需要进一步研究为什么男性和女性相对于配偶的死亡会有不同的医疗保健支出模式。
