The Case of Disability in the Family: Impact on Health Care Utilization and Expenditures for Nondisabled Members

Altman, Barbara M.; Cooper, Philip; Cunningham, Peter

doi:10.1111/1468-0009.00124

Cited by 67 publications

(49 citation statements)

References 26 publications

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“…Existing research has documented that large out-of-pocket expenditures tend to reduce access to needed health services and force decisions among such essentials as housing, transportation, and food, ultimately resulting in a compromised quality of life and health status (Altman, Cooper, & Cunningham, 1999).This concern is similar to the new Medicare prescription drug plan's ''donut hole'' problem (after one's prescription medication plan has paid 75% of the amount from $251 through $2,250, the individual will be responsible for all prescription drug costs until the catastrophic benefit level of $5,100). This lack of coverage will disproportionately affect those with several prescriptions who are on small, fixed incomes but who are not indigent.…”

Section: Discussionmentioning

confidence: 99%

Burden of Common Multiple-Morbidity Constellations on Out-of-Pocket Medical Expenditures Among Older Adults

Schoenberg¹,

Kim²,

Edwards³

et al. 2007

The Gerontologist

100

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Purpose: On average, adults aged 60 years or older have 2.2 chronic diseases, contributing to the over 60 million Americans with multiple morbidities. We aimed to understand the financial implications of the most frequent multiple morbidities among older adults. Design and Methods: We analyzed Health and Retirement Study data, determining out-of-pocket medical expenses from 1998 and 2002 separately and examining differences in the impact of multiplemorbidity constellations on these expenses. We paid particular attention to the most common disease constellations-hypertension, arthritis, and heart disease. Results: An increasing prevalence of multiple morbidity (58% compared with 70% of adults had two or more chronic conditions in 1998 and 2002, respectively) was accompanied by escalating out-ofpocket expenditures ($2,164 in 1998, increasing by 104% to $3,748 in 2002). Individuals with two, three, and four chronic conditions had health care expenditure increases of 41%, 85%, and 100%, respectively, over 4 years. Such patterns were particularly noticeable among the oldest old, those with higher educational attainment, and women, although having supplementary health insurance or Medicaid mitigated these expenses. Finally, there were significant differences in out-of-pocket expenditure levels among the multiple-morbidity combinations. Implications: Increasing rates of multiple morbidities in conjunction with escalating health care costs and stable or declining incomes among elders warrant creative attention from providers, researchers, and policy makers. Further understanding how specific multiple-morbidity constellations impact outof-pocket spending moves us closer to effective interventions to support vulnerable elders.

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Section: Discussionmentioning

confidence: 99%

Burden of Common Multiple-Morbidity Constellations on Out-of-Pocket Medical Expenditures Among Older Adults

Schoenberg¹,

Kim²,

Edwards³

et al. 2007

The Gerontologist

100

View full text Add to dashboard Cite

show abstract

“…High levels of out-of-pocket (OOP) spending for health care are potentially problematic because they may lead patients to forego needed services and medications as well as hamper their ability to pay for other essential goods such as food and housing, leading to sharp reductions in quality of life. 1-4 High OOP spending among those with illness and injury has also been cited as a common cause for personal bankruptcy. 5 The significance of this issue is underscored by recent trends toward increasing out-of-pocket (OOP) health care spending; one in ten Medicare recipients spend at least 60 percent of their income on health care costs, up from 48 percent in 1997.…”

Section: Introductionmentioning

confidence: 99%

Dementia and out‐of‐pocket spending on health care services

Delavande

Hurd

Martorell

et al. 2012

Alzheimer's & Dementia

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Background High levels of out-of-pocket (OOP) spending for health care may lead patients to forego needed services and medications, as well as hamper their ability to pay for other essential goods. Dementia, because it leads to disability and the loss of independence may put patients and their families at risk for high OOP spending, especially for long-term care services. Methods We used data from the Aging, Demographics, and Memory Study, a nationally representative sub-sample (n=743) of the Health and Retirement Study, to determine whether individuals with dementia had higher self-reported OOP spending compared to those with cognitive impairment without dementia (CIND) and those with normal cognitive function. We also examined the relationship between dementia and utilization of dental care and prescription medications, two types of health care that are frequently paid for out-of-pocket. Multivariate and logistic regression models were used to adjust for the influence of potential confounders. Results After controlling for demographics and comorbidities, those with dementia had more than three times the yearly OOP spending compared to those with normal cognition ($8,216 for those with dementia vs. $2,570 for those with normal cognition, p<.01) Higher OOP spending for those with dementia was mainly driven by greater expenditures on nursing home care (p<.01). Dementia was not associated with the likelihood of visiting the dentist (p=0.76) or foregoing prescription medications due to cost (p=.34). Conclusions Dementia is associated with high levels of OOP spending, but not with the use of dental care or foregoing prescription medications, suggesting that excess OOP spending among those with dementia does not “crowd out” spending on these other health care services.

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“…6 Caregiving can also adversely impact parents’ physical and mental health 4,5 which may indirectly compromise their ability to engage fully in the labor force. 7 …”

mentioning

confidence: 99%

Financial and Nonfinancial Burden Among Families of CSHCN: Changes Between 2001 and 2009–2010

Ghandour¹,

Hirai²,

Blumberg³

et al. 2014

Academic Pediatrics

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Objective We use the latest data to explore multiple dimensions of financial burden among children with special health care needs (CSHCN) and their families in 2009–2010 and changes since 2001. Methods Five burden indicators were assessed using the 2001 and 2009–2010 National Surveys of CSHCN: past-year health-related out-of-pocket expenses of ≥$1,000 or ≥3% of household income; perceived financial problems; changes in family employment; and >10 hours of weekly care provision/coordination. Unadjusted and adjusted prevalence estimates were used to assess burden in 2009–2010 and calculate absolute and relative measures of change since 2001. Prevalence rate ratios for each burden type in 2009–2010 compared to 2001 were estimated by logistic regression. Results Nearly half of CSHCN and their families experienced some form of burden in 2009–2010. The percentage of CSHCN living in families that paid ≥$1,000 or ≥3% of household income out of pocket for health care rose 120% and 35%, respectively, between 2001 and 2009–2010, while the prevalence of caregiving and employment burdens declined. Relative to 2001, in 2009–2010, CSHCN who were privately insured or least affected by their conditions were 1.7 times as likely to live in families that paid ≥3% of household income out of pocket, while publicly insured children were 20% less likely to do so and those most severely affected were 12% more likely to do so. Conclusions Over the past decade, increases in financial burden and declines in employment and caregiving burdens were observed for CSHCN families. Public insurance expansions may have buffered increases in financial burden, yet disparities persist.

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The Case of Disability in the Family: Impact on Health Care Utilization and Expenditures for Nondisabled Members

Cited by 67 publications

References 26 publications

Burden of Common Multiple-Morbidity Constellations on Out-of-Pocket Medical Expenditures Among Older Adults

Burden of Common Multiple-Morbidity Constellations on Out-of-Pocket Medical Expenditures Among Older Adults

Dementia and out‐of‐pocket spending on health care services

Financial and Nonfinancial Burden Among Families of CSHCN: Changes Between 2001 and 2009–2010

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