Monday, April 21
Grant Miller: Managerial Incentives in Public Service Delivery
Langa, Kenneth M., E.B. Larson, R.B. Wallace, A. Mark Fendrick, N.L. Foster, M.U. Kabeto, David Weir, and Robert Willis. 2004. "Out-of-Pocket Health Care Expenditures Among Older Americans With Dementia." Alzheimer Disease & Associated Disorders, 18(2): 90-98.
The number of older individuals with dementia will likely increase significantly in the next decades, but there is currently limited information regarding the out-of-pocket expenditures (OOPE) for medical care made by cognitively impaired individuals and their families. We used data from the 1993 and 1995 Asset and Health Dynamics Study, a nationally representative longitudinal survey of older Americans, to determine the OOPE for individuals with and without dementia. Dementia was identified in 1993 using a modified version of the Telephone Interview for Cognitive Status for self-respondents, and proxy assessment of memory and judgment for proxy respondents. In 1995, respondents reported OOPE over the prior 2 years for: 1) hospital and nursing home stays, 2) outpatient services, 3) home care, and 4) prescription medications. The adjusted mean annual OOPE was $1,350 for those without dementia, $2,150 for those with mild/moderate dementia, and $3,010 for those with severe dementia (p < 0.01). Expenditures for hospital/nursing home care ($1,770 per year) and prescription medications ($800 per year) were the largest OOPE components for those with severe dementia. We conclude that dementia is independently associated with significantly higher OOPE for medical care compared with those with normal cognitive function. Severe dementia is associated with a doubling of OOPE, mainly due to higher payments for long-term care. Given that the number of older Americans with dementia will likely increase significantly in the coming decades, changes in public funding aimed at reducing OOPE for both long-term care and prescription medications would have considerable impact on individuals with dementia and their families.