Alzheimer Disease and Related Disorders and Out-of-Pocket Health Care Spending and Burden Among Elderly Medicare Beneficiaries
Open accessAbstract
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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Individuals with Alzheimer's dementia spend 12% of their annual income on out-of-pocket health care services, excluding nursing home and informal care, compared with 7% for individuals without Alzheimer's dementia.
“Furthermore, individuals with Alzheimer's dementia spend 12% of their annual income on out-of-pocket health care services, excluding nursing home and informal care, compared with 7% for individuals without Alzheimer's dementia.720”
From 2023 Alzheimer's disease facts and figures (2023) · cites this paper as [720]
The Results section, “Out-of-Pocket Spending Burden by ADRD Status,” reports that people with Alzheimer’s disease and related disorders (ADRD) spent 12% of income on medical services, versus 7% for those without ADRD. The paper studied ADRD as a group, not Alzheimer’s dementia alone; its Discussion also says the sample did not include nursing-home spending. (LLM, conf=0.85)
Experimental — accuracy not yet measuredHigher 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 [867]
The Abstract (Results and Conclusion; page unavailable) attributes excess out-of-pocket spending among elderly Medicare beneficiaries with ADRD primarily to prescription drugs and home health care. The Discussion (page unavailable) says the study included community-dwelling elderly people and did not include nursing home spending, so this source does not support nursing home care as a contributor. (LLM, conf=0.90)
Experimental — accuracy not yet measuredIndividuals with Alzheimer's dementia spend 12% of their annual income on out-of-pocket health care services on average, excluding nursing home and informal care, compared with 7% for individuals without Alzheimer's dementia.
“Furthermore, individuals with Alzheimer's dementia spend 12% of their annual income on out‐of‐pocket health care services on average, excluding nursing home and informal care, compared with 7% for individuals without Alzheimer's dementia. 867”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [867]
The Results (Out-of-Pocket Spending Burden by ADRD Status; page unavailable) report that people with Alzheimer’s disease and related disorders (ADRD) spent 12% of income on medical services, versus 7% for those without ADRD. The Discussion says the community-living sample excluded nursing-home spending, and the Methods’ spending components do not include informal care. The figures match, but the claim narrows the studied ADRD group to people with Alzheimer’s dementia specifically. (LLM, conf=0.84)
Experimental — accuracy not yet measured
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- Authors
- Dwibedi, N., Findley, P. A., Wiener R, C., Shen, C., & Sambamoorthi, U.
- Affiliations
- West Virginia University (US)
- Rutgers, The State University of New Jersey (US)
- Department of Dental Practice and Rural Health, School of Dentistry, West Virginia University, Morgantown, WV
- The University of Texas MD Anderson Cancer Center (US)
- Corresponding author
- Dwibedi, Nilanjana
- Sambamoorthi, Usha
- Venue
- Medical Care
- Published
- 2018-03
- Volume
- 56
- Issue
- 3
- Pages
- 240-246
- ISSN
- 0025-7079 (ISSN-L)
- PMC
- PMC5811350
- OpenAlex
- W2782436410
- Cited by
- 39
- References
- 34
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 6 · 2023: 6 · 2022: 7 · 2021: 6 · 2020: 4 · 2019: 2 · 2017: 1
- FWCI
- 4.56
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Medical Care (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- The Research Repository @ WVU (West Virginia University) (submittedVersion)
- Funders
- National Institute of General Medical Sciences (U54GM104942)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Financial Impacts of Cancer
- Keywords
- Alzheimer's disease and related dementias, healthcare burden, Medicare beneficiaries, older adults, home health care, prescription drug costs, health care expenditure, Medicare Current Beneficiary Survey
- MeSH terms
- Aged, Aged, 80 and over, Alzheimer Disease, Cross-Sectional Studies, Delivery of Health Care, Health Expenditures, Female, Medicare, Humans, Income, Male, Surveys and Questionnaires, Retrospective Studies, United States, Cost of Illness
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