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

Publication type

Journal Article


Publication date

June 1, 2013


 BackgroundHigh 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. Because it leads to disability and the loss
of independence, dementia may put patients and their families at risk
for high OOP spending, especially for long-term care services.MethodsWe
used data from the Aging, Demographics, and Memory Study, a nationally
representative subsample (n = 743) of the Health and Retirement Study,
to determine whether individuals with dementia had higher self-reported
OOP spending compared with those with cognitive impairment without
dementia 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 OOP. Multivariate and logistic regression models were used to
adjust for the influence of potential confounders.ResultsAfter
controlling for demographics and comorbidities, those with dementia had
more than three times the yearly OOP spending compared with those with
normal cognition ($8216 for those with dementia vs. $2570 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 = .76) or foregoing prescription medications owing to cost (P = .34).ConclusionsDementia
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.

Published in

Alzheimer's & Dementia

Volume and page numbers

Volume: 9 , p.19 -29






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