Out-of-pocket medical spending and Charon's obol.
Out-of-pocket medical spending and Charon's obol.
复制标题
自付费用的医疗支出和卡戎的奥博尔。
DOI：
10.1007/s11606-012-2265-4
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发表时间：
2013
影响因子：
5.7
通讯作者：
McWilliams,JMichael
中科院分区：
文献类型：
--
作者：
McWilliams,JMichael
在这一期的JGIM中，Kelley等人。使用来自健康和退休研究的具有全国代表性的调查数据，检查了3,209名联邦医疗保险受益人在最后5年的自付家庭医疗支出。1对于在2002至2008年间去世的受益人，他们发现这一支出平均为38,688美元，从最低四分位数的死者的5,163美元到最高十分位数的死者的163,121美元不等。从高支出死者的社会人口学和临床特征中浮现出来的故事，并不是一种经济上灾难性的急性疾病发作，尽管这种发作几乎肯定起到了作用。相反，在家庭支出的前十位中，死者更有可能是残疾人，居住在疗养院，并患有预测残疾和长期护理需求的疾病，如中风、跌倒和痴呆症。对于这一群体，58%的自付支出用于养老院护理。这些发现提醒人们，老年人可获得的公共和私人医疗保险组合中的一个主要不足--缺乏负担得起的长期护理保险。高自付支出也集中在有更多能力支付长期护理费用的较富裕家庭。正如作者指出的那样，越富有的老年人寿命越长，相应地，在生命结束时，长期护理需求的风险也可能更高。这些发现提出了一个分析没有直接解决的根本问题：多少自掏腰包的支出才算太多？当然，医疗保险的一个主要目的是保护家庭免受疾病的贫困。然而，可以说，该计划的目的并不是支持富裕家庭利用不太富裕家庭的贡献进行代际财富转移，如果将长期护理的无限覆盖作为一项福利，可能会发生这种情况。
I n this issue of JGIM, Kelley et al. used nationally representative survey data from the Health and Retirement Study to examine out-of-pocket household spending on medical care for 3,209 Medicare beneficiaries in the last 5 years of life. 1 For beneficiaries dying between 2002 and 2008, they found this spending averaged $38,688, ranging from $5,163 for decedents in the bottom quartile to $163,121 for those in the top decile. The story emerging from the sociodemographic and clinical characteristics of decedents with high spending was not one of financially catastrophic episodes of acute illness, although such episodes almost surely contributed. Rather, decedents in the top decile of household spending were more likely to be disabled, reside in nursing homes, and have conditions predictive of disability and long-term care needs, such as strokes, falls, and dementia. For this group, 58% of out-of-pocket spending was devoted to nursing home care. These findings serve as a sobering reminder of a major deficiency in the mix of public and private health insurance available to seniors—the lack of affordable coverage for long-term care. High out-of-pocket spending was also concentrated among wealthier households with greater means to pay for long-term care. As the authors noted, wealthier seniors live longer and may accordingly have a higher risk for long-term care needs at the end of life. These findings beg a fundamental question not directly addressed by the analysis: how much out-of-pocket spending is too much? Certainly, a primary purpose of Medicare is to protect households against impoverishment from sickness. The program’s purpose is arguably not, however, to support intergenerational transfers of wealth in affluent families with contributions from those less well-off, as might occur if limitless coverage for long-term care were included as a benefit.