The relationship between lifetime out-of-pocket medical expenditures, dementia, and socioeconomic status in the U.S
Open accessAbstract
Dementia is one of the most expensive medical conditions. The costs are borne by families, by private insurance and by society via public programs such as Medicaid in the U.S.. There is extensive research on the relationship between dementia and annual medical spending. This paper, instead, estimates cumulative lifetime medical expenditures that can be attributed to the onset of dementia using a nationally representative longitudinal survey from the U.S., the Health and Retirement Study. The lifetime expenditures are estimated by summing any out-of-pocket medical spending reported in the panel from age 65 to death. Censored cases are imputed using a non-parametric matching algorithm called splicing. For example, survivors to the most recent wave are matched to similar individuals from older cohorts who are observed at the relevant ages all the way through death. We find that those who live with dementia for at least half a year pay, on average, $38,540 more out of pocket from age 65 to death when controlling for length of life, demographics, lifetime earnings and comorbidities. The costs of dementia are almost exclusively due to spending on nursing homes. Spending on drugs, doctor visits or hospitals, is not significantly related to dementia. The lifetime costs of dementia are significantly larger for white and rich individuals, perhaps because they use higher quality nursing homes and because they have more financial resources to spend down before becoming eligible for Medicaid support.
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Higher out-of-pocket costs for Alzheimer's and other dementias have been attributed to nursing home care, home health care, and prescription drug payments.
“Higher out‐of‐pocket costs for Alzheimer's and other dementias have been attributed to nursing home care, home health care and prescription drug payments. 866 , 867”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [866]
The Results section reports that dementia significantly increases out-of-pocket nursing-home spending. It does not support attributing the increase to home health care or prescription drugs: it says nursing homes were the only spending subcategory affected, and the Abstract says drug spending was not significantly related to dementia. (LLM, conf=0.90)
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- Authors
- Hudomiet, P., Hurd, M. D., & Rohwedder, S.
- Affiliations
- RAND Corporation (US)
- Corresponding author
- Hudomiet, Péter
- Venue
- The Journal of the Economics of Ageing
- Publisher
- Elsevier BV
- Published
- 2019
- Volume
- 14
- Pages
- 100181
- ISSN
- 2212-828X (ISSN-L)
- PMC
- PMC6874215
- OpenAlex
- W2902856083
- Cited by
- 24
- References
- 41
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 2 · 2023: 5 · 2022: 4 · 2021: 3 · 2020: 1 · 2019: 1
- FWCI
- 0.98
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of the Economics of Ageing (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- National Institute on Aging (U01AG009740, R01AG053972)
- U.S. Social Security Administration
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Health Professions › General Health Professions › Global Health Care Issues
- Keywords
- dementia, socioeconomic status, nursing home costs, Medicaid eligibility, racial disparities, health care costs, older adults, Health and Retirement Study
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