Marital status, living arrangements, and the use of health services by elderly persons.

Although marriage has been shown to have important health-protective consequences, it is not clear to what extent these effects are due to marriage per se or to the fact that married people are less likely to live alone. The social support literature suggests that living with others may reduce the need for use of formal and informal health care services independently of marital status because of (a) the substitution of home care, and/or (b) enhancement of physical and mental health. This study of elderly persons, based on data from the National Medical Care Expenditure Survey (NMCES), examined the substitution hypothesis. The impact of marital status and living arrangements on the use of formal health services among persons 65 years of age and older was examined using path analysis. These data confirm a substitution effect whereby persons living with others are more likely to stay in bed, but less likely to see a doctor, than are persons who live alone.