The burden of health care costs for patients with dementia in the last 5 years of life.
The burden of health care costs for patients with dementia in the last 5 years of life.
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DOI：
10.7326/m15-0381
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发表时间：
2015-11-17
影响因子：
39.2
通讯作者：
Skinner JS
中科院分区：
文献类型：
--
作者：
Kelley AS;McGarry K;Gorges R;Skinner JS
常见疾病，特别是痴呆症，会带来巨大的社会成本，这在以前的美国人口中得到了很好的描述。对具体疾病的临终费用和单个家庭的相关财务风险知之甚少。研究医疗保险受益人在死亡前五年所面临的社会成本和财务风险。回顾性队列。健康与退休研究医疗保险按服务收费的受益人，年龄在70岁或以上，2005-2010年死亡（N = 1702），分为四个队列：患有痴呆症的高概率，或患有心脏病，癌症或其他死亡原因的个人。总社会成本及其组成部分：医疗保险，医疗补助，私人保险，自付和非正式护理，在过去5年的生活中测量;以及自付支出占家庭财富的比例。痴呆症的平均总成本（287，038美元）显著高于死于心脏病（175，136美元），癌症（173，383美元）或其他原因（197，286美元）的人，p<0.001。虽然医疗保险支出在各组之间相似，但痴呆症患者的平均自付支出（61，522美元）比非痴呆症患者（34，068美元）高出81%;非正式护理也有类似的模式。痴呆症组的自付支出（中位数为36，919美元）占死亡前五年测量的财富的32%，而非痴呆症死者为11%（p<0.001）。这一比例在黑人（84%）、高中以下学历者（48%）和未婚/丧偶妇女（58%）中更高。估算的医疗补助，私人保险和非正式护理费用痴呆症患者的医疗保健支出远远大于其他疾病，其中大部分费用没有保险，因此给家庭带来了巨大的经济负担。这些负担在对金融风险准备不足的人口群体中尤为突出。
Common diseases, particularly dementia, entail large social costs, previously well described for the U.S. population. Less is known about end-of-life costs of specific diseases and the associated financial risk for individual households. To examine social costs and financial risks faced by Medicare beneficiaries five years before death. Retrospective cohort. Health and Retirement Study. Medicare fee-for-service beneficiaries, aged 70 years or older, who died 2005-2010 (N = 1702), stratified into four cohorts: individuals with high probability of dementia, or with either heart disease, cancer, or other causes of death. Total social costs and its components: Medicare, Medicaid, private insurance, out-of-pocket, and informal care, measured over the last 5 years of life; and out-of-pocket spending as a proportion of household wealth. Average total cost per decedent for dementia ($287,038) was significantly greater than for those who died of heart disease ($175,136), cancer ($173,383), or other causes ($197,286), p<0.001. While Medicare expenditures were similar across groups, average out-of-pocket spending for dementia patients ($61,522) was 81% higher than for non-dementia patients ($34,068); a similar pattern held for informal care. Out-of-pocket spending for the dementia group (median, $36,919) represented 32% of wealth measured five years before death, compared to 11% for non-dementia decedents (p<0.001). This proportion was greater for Blacks (84%), those with less than high school education (48%), and unmarried/widowed women (58%). Imputed Medicaid, private insurance and informal care costs Healthcare expenditures among those with dementia were substantially larger than for other diseases, with much of those expenses uninsured, thus placing a large financial burden on families. These burdens are particularly pronounced among demographic groups least prepared for financial risk.