Changes in Health Care Expenditure after the Loss of a Spouse: Data on 6,487 Older Widows and Widowers in the Netherlands

Abstract

BackgroundIn ageing populations, informal care holds great potential to limit rising health care expenditure. The majority of informal care is delivered by spouses. The loss of informal care due to the death of the spouse could therefore increase expenditure levels for formal care.ObjectiveTo investigate the impact of the death of the spouse on health care expenditure by older people through time. Additionally, to examine whether the impact differs between socio-demographic groups, and what health services are affected most.DesignLongitudinal data on health care expenditure (from July 2007 through 2010) from a regional Dutch health care insurer was matched with data on marital status (2004–2011) from the Central Bureau of Statistics. Linear mixed models with log transformed health care expenditure, generalized linear models and two-part models were used to retrieve standardized levels of monthly health care expenditure of 6,487 older widowed subjects in the 42 months before and after the loss of the spouse.ResultsMean monthly health care expenditure in married subjects was €502 in the 42 months before the death of the spouse, and expenditure levels rose by €239 (48%) in the 42 months after the death of the spouse. The increase in expenditure after the death of the spouse was highest for men (€319; 59%) and the oldest old (€553; 82%). Expenditure levels showed the highest increase for hospital and home care services (together €166).ConclusionsThe loss of the spouse is associated with an increase in health care expenditure. The relatively high rise in long-term care expenses suggests that the loss of informal care is an important determinant of this rise.

Does the risk of hospitalisation for ischaemic heart disease rise alreadybeforewidowhood?

“…This prewidowhood increase cannot be compared with the findings of Mostofsky et al 16 or those of mortality studies10 11 because these lack repeated measures of health outcomes before bereavement. However, our findings for men are somewhat consistent with the results of an earlier Dutch study on healthcare expenditures 42 months before and after widowhood suggesting that the average expenditure level rises a few months before widowhood among individuals over 80 years old, and remains at a heightened level after widowhood 20. Rolden et al 20 suggested that the expenditure levels predominantly rose because of an increased need for formal care after the death of an informal caregiver, rather than an increased need for medical treatment related to the health impact of bereavement.…”

“…However, our findings for men are somewhat consistent with the results of an earlier Dutch study on healthcare expenditures 42 months before and after widowhood suggesting that the average expenditure level rises a few months before widowhood among individuals over 80 years old, and remains at a heightened level after widowhood 20. Rolden et al 20 suggested that the expenditure levels predominantly rose because of an increased need for formal care after the death of an informal caregiver, rather than an increased need for medical treatment related to the health impact of bereavement. This argument was justified by the fact that the increase in expenditure levels after widowhood was especially high in the long-term care sector.…”

“…Second, it is possible that a spouse's approaching death intensifies informal caregiving burdens,20 which can cause health problems for the caregiver. Caregiving has previously been suggested to increase the risk of ischaemic heart disease 37.…”

“…Furthermore, the process of widowhood may involve intensified caregiving burdens before the loss,20 and reduce participation in other activities. Widowhood is thus not necessarily an unexpected external shock for the surviving spouse; rather, it is a complex process that could cause acute and chronic stress even prior to the actual loss.…”

Marital status is an independent prognostic factor for tracheal cancer patients: an analysis of the SEER database

“…In addition, married status generally reflects a better financial situation, which has been reported to improve prognosis [36]. Furthermore, unmarried patients may have additional health care expenditures, as spouses are the major source of outpatient/informal care [37]. Previous studies have found that married patients are more likely to receive better quality clinical care, choose better medical centers, be more compliant with medical recommendations, receive more aggressive treatments, and recover better from surgery, all of which contribute to a better prognosis [38–40].…”