Alzheimer Disease and Related Disorders and Out-of-Pocket Health Care Spending and Burden among Elderly Medicare Beneficiaries

Nilanjana Dwibedi, Patricia A. Findley, Constance R. Wiener, Chan Shen, Usha Sambamoorthi

Research output: Contribution to journalArticle

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Abstract

Objective: To estimate the excess burden of out-of-pocket health care spending associated with Alzheimer disease and related disorders (ADRD) among older individuals (age 65 y and older). Methods: We adopted a retrospective, cross-sectional study design with data from 2012 Medicare Current Beneficiary Survey. The study sample comprised of elderly community-dwelling individuals who had positive total health care expenditures, and enrolled in Medicare throughout the calendar year (462 with ADRD, and 7160 without ADRD). We estimated the per-capita total annual out-of-pocket spending on health care and out-of-pocket spending by service type: Inpatient, outpatient, home health, prescription drugs, and other services. We measured out-of-pocket spending burden by calculating the percentage of income spent on health care and defined high out-of-pocket spending burden as having this percentage above 10%. Multivariable analyses included ordinary least squares regressions and logistic regressions and these analyses adjusted for predisposing, enabling, need, personal health care practices and external environment characteristics. Results: The average annual per-capita out-of-pocket health care spending was greater among individuals with ADRD compared with those without ADRD ($3285 vs. $1895); home health and prescription drugs accounted for 52% of total out-of-pocket spending among individuals with ADRD and 34% among individuals without ADRD. Elderly individuals with ADRD were more likely to have high out-of-pocket spending burden (adjusted odds ratio, 1.49; 95% confidence interval, 1.13-1.97) compared with those without ADRD. Conclusion: ADRD is associated with excess out-of-pocket health care spending, primarily driven by prescription drugs and home health care use.

Original languageEnglish (US)
Pages (from-to)240-246
Number of pages7
JournalMedical care
Volume56
Issue number3
DOIs
StatePublished - Jan 1 2018

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Medicare
Alzheimer Disease
Health Expenditures
Delivery of Health Care
Prescription Drugs
Independent Living
Health
Home Care Services
Ambulatory Care
Least-Squares Analysis
Inpatients
Cross-Sectional Studies
Logistic Models
Odds Ratio
Regression Analysis
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Public Health, Environmental and Occupational Health

Cite this

Dwibedi, Nilanjana ; Findley, Patricia A. ; Wiener, Constance R. ; Shen, Chan ; Sambamoorthi, Usha. / Alzheimer Disease and Related Disorders and Out-of-Pocket Health Care Spending and Burden among Elderly Medicare Beneficiaries. In: Medical care. 2018 ; Vol. 56, No. 3. pp. 240-246.
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abstract = "Objective: To estimate the excess burden of out-of-pocket health care spending associated with Alzheimer disease and related disorders (ADRD) among older individuals (age 65 y and older). Methods: We adopted a retrospective, cross-sectional study design with data from 2012 Medicare Current Beneficiary Survey. The study sample comprised of elderly community-dwelling individuals who had positive total health care expenditures, and enrolled in Medicare throughout the calendar year (462 with ADRD, and 7160 without ADRD). We estimated the per-capita total annual out-of-pocket spending on health care and out-of-pocket spending by service type: Inpatient, outpatient, home health, prescription drugs, and other services. We measured out-of-pocket spending burden by calculating the percentage of income spent on health care and defined high out-of-pocket spending burden as having this percentage above 10{\%}. Multivariable analyses included ordinary least squares regressions and logistic regressions and these analyses adjusted for predisposing, enabling, need, personal health care practices and external environment characteristics. Results: The average annual per-capita out-of-pocket health care spending was greater among individuals with ADRD compared with those without ADRD ($3285 vs. $1895); home health and prescription drugs accounted for 52{\%} of total out-of-pocket spending among individuals with ADRD and 34{\%} among individuals without ADRD. Elderly individuals with ADRD were more likely to have high out-of-pocket spending burden (adjusted odds ratio, 1.49; 95{\%} confidence interval, 1.13-1.97) compared with those without ADRD. Conclusion: ADRD is associated with excess out-of-pocket health care spending, primarily driven by prescription drugs and home health care use.",
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Alzheimer Disease and Related Disorders and Out-of-Pocket Health Care Spending and Burden among Elderly Medicare Beneficiaries. / Dwibedi, Nilanjana; Findley, Patricia A.; Wiener, Constance R.; Shen, Chan; Sambamoorthi, Usha.

In: Medical care, Vol. 56, No. 3, 01.01.2018, p. 240-246.

Research output: Contribution to journalArticle

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T1 - Alzheimer Disease and Related Disorders and Out-of-Pocket Health Care Spending and Burden among Elderly Medicare Beneficiaries

AU - Dwibedi, Nilanjana

AU - Findley, Patricia A.

AU - Wiener, Constance R.

AU - Shen, Chan

AU - Sambamoorthi, Usha

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: To estimate the excess burden of out-of-pocket health care spending associated with Alzheimer disease and related disorders (ADRD) among older individuals (age 65 y and older). Methods: We adopted a retrospective, cross-sectional study design with data from 2012 Medicare Current Beneficiary Survey. The study sample comprised of elderly community-dwelling individuals who had positive total health care expenditures, and enrolled in Medicare throughout the calendar year (462 with ADRD, and 7160 without ADRD). We estimated the per-capita total annual out-of-pocket spending on health care and out-of-pocket spending by service type: Inpatient, outpatient, home health, prescription drugs, and other services. We measured out-of-pocket spending burden by calculating the percentage of income spent on health care and defined high out-of-pocket spending burden as having this percentage above 10%. Multivariable analyses included ordinary least squares regressions and logistic regressions and these analyses adjusted for predisposing, enabling, need, personal health care practices and external environment characteristics. Results: The average annual per-capita out-of-pocket health care spending was greater among individuals with ADRD compared with those without ADRD ($3285 vs. $1895); home health and prescription drugs accounted for 52% of total out-of-pocket spending among individuals with ADRD and 34% among individuals without ADRD. Elderly individuals with ADRD were more likely to have high out-of-pocket spending burden (adjusted odds ratio, 1.49; 95% confidence interval, 1.13-1.97) compared with those without ADRD. Conclusion: ADRD is associated with excess out-of-pocket health care spending, primarily driven by prescription drugs and home health care use.

AB - Objective: To estimate the excess burden of out-of-pocket health care spending associated with Alzheimer disease and related disorders (ADRD) among older individuals (age 65 y and older). Methods: We adopted a retrospective, cross-sectional study design with data from 2012 Medicare Current Beneficiary Survey. The study sample comprised of elderly community-dwelling individuals who had positive total health care expenditures, and enrolled in Medicare throughout the calendar year (462 with ADRD, and 7160 without ADRD). We estimated the per-capita total annual out-of-pocket spending on health care and out-of-pocket spending by service type: Inpatient, outpatient, home health, prescription drugs, and other services. We measured out-of-pocket spending burden by calculating the percentage of income spent on health care and defined high out-of-pocket spending burden as having this percentage above 10%. Multivariable analyses included ordinary least squares regressions and logistic regressions and these analyses adjusted for predisposing, enabling, need, personal health care practices and external environment characteristics. Results: The average annual per-capita out-of-pocket health care spending was greater among individuals with ADRD compared with those without ADRD ($3285 vs. $1895); home health and prescription drugs accounted for 52% of total out-of-pocket spending among individuals with ADRD and 34% among individuals without ADRD. Elderly individuals with ADRD were more likely to have high out-of-pocket spending burden (adjusted odds ratio, 1.49; 95% confidence interval, 1.13-1.97) compared with those without ADRD. Conclusion: ADRD is associated with excess out-of-pocket health care spending, primarily driven by prescription drugs and home health care use.

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