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87% of the 3,078 older adults with CVD report having positive (i.e. at least one dollar of) total OOP spending. However, the proportions of individuals with positive spending in the detailed expenditure categories are smaller . Among the 3,078 older adults with CVD, only 12% incur inpatient spending, 69% incur non-inpatient spending, and 74% incur prescription drug spending. Of note, in particular, is the observation that more people spend on non-inpatient services and prescription drugs than inpatient services. Average inpatient spending ranges between $1,067 and $1,540, which is considerably higher than the mean expenditures of $679–1,092 reported in the other two expenditure categories.
Data and sample
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Out-of-pocket health spending among Medicare beneficiaries: Which chronic diseases are most costly?
Standard specification tests conducted support the use of the log link and the gamma distribution [29–30]. A series of goodness-of-fit tests further confirm that the fitted models do not have significant specification errors. For each outcome variable, we combine the results of the first and second parts to estimate average spending across different disease types. To ensure generalizability of the study findings to the U.S. population, we take into account the complex sample design of the HRS via individual-level sampling weights in all regressions. Statistical analyses are performed using STATA version 14.0 (STATA Corp., TX, USA).
In this paper, we assess the impact of chronic diseases on older adults’ OOP medical spending and evaluate whether certain conditions are costlier in terms of additional spending needs. Health service-specific components that drive the increased spending for costly conditions are also identified. We use a nationally representative sample of non-institutionalized, Medicare beneficiaries aged 65+ from the Health and Retirement Study . A multivariate two-part regression model is implemented to estimate the marginal effects of various NCDs, including cancer, diabetes, and CVD, on total spending. This decomposition analysis may be useful for health administrators and policymakers to target interventions. Our analyses were also informative on the health service-specific components that drive increased spending.
Statistical analysis
Additionally, costs of hospitalization care and/or overnight nursing home use also contributes significantly to the high costs of care for community-dwelling older adults with CVD. For the fourth costliest chronic condition–cancer–the key driver of increased spending is non-inpatient services , which accounts for 48% of the total excess spending. Noncommunicable diseases are among the most prevalent and costly health conditions in the United States. As of 2013, two out of every three older Americans have two or more chronic health conditions . Older adults have higher prevalence of chronic diseases than younger adults. According to nationwide statistics from the American Heart Association , about 85% of Americans aged 65+ have cardiovascular diseases as compared to 50% for those aged 45–64.
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Concern Home Care
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The next section describes the HRS data, sample, and variables used in the empirical model. Section 4 presents the estimation results highlighting the effects of chronic conditions, as well as other factors, on OOP spending. Section 5 extends those results by performing a decomposition analysis to pinpoint sources of excess spending for the four costliest chronic conditions. Little is known about the impact of different types of chronic diseases on older adults’ out-of-pocket healthcare spending and whether certain diseases trigger higher spending needs than others.
Thus, on an adjusted basis, the four ‘costliest’ chronic conditions are , whether in absolute or relative terms. About 18% of sampled respondents report not having any form of OOP spending. This suggests that the total spending distribution is skewed rightwards with a mass point at zero. The GLM framework implemented in the second part takes into account the right-skewness and avoids potential bias issues in retransformation.
Wealth is considered in addition to income because elderly persons may draw on accumulated assets to pay for healthcare. In addition, many may have also exited the labour market at ages past 65. Chronic diseases are on the rise and older adults face the challenge of coping financially with these expensive long-lasting conditions. Recognizing that some chronic conditions may be relatively more costly for individuals in terms of additional OOP spending needs could contribute to more effective targeting of health interventions.
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For instance persons with and without CVD spend $1,689 and $1,224, respectively, on average, while persons with and without cancer spend $1,616 and $1,337, respectively. The difference in means, e.g. $279 [$1616–1337] for cancer, reflects the increased or excess spending among persons with that disease . Before adjusting for any confounding factors, increased spending is largest for CVD ($465), followed by diabetes ($357), chronic lung disease ($323), and finally, cancer ($279). The increased spending of other chronic conditions, e.g. arthritis is $193–270. Excess spending evaluated in percentage terms produce the same ranking. Thus, on an unadjusted basis, the four costliest chronic conditions are identical to WHO’s ‘big four’ NCDs.
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