NATIONAL TRENDS IN CATASTROPHIC HEALTH EXPENDITURE AND OUT-OF-POCKET SPENDING AMONG U.S. OLDER ADULTS WITH DEMENTIA: 2012-2021
Author(s)
Shanshan Li, MPhil1, Xinyi Zhu, Master2, Beini Lyu, MD3, Ming Xu, PHD4;
1Department of Global Health, School of Public Health, Peking University, STUDENT, BEIJING, China, 2Beijing-Dublin International College, Beijing University of Technology, BEIJING, China, 3Institute for Global Health and Development, Peking University, Beijing, China, 4Department of Global Health, School of Public Health, Peking University, BEIJING, China
1Department of Global Health, School of Public Health, Peking University, STUDENT, BEIJING, China, 2Beijing-Dublin International College, Beijing University of Technology, BEIJING, China, 3Institute for Global Health and Development, Peking University, Beijing, China, 4Department of Global Health, School of Public Health, Peking University, BEIJING, China
OBJECTIVES: While dementia poses a significant economic threat, longitudinal trends of financial protection specifically the extent to which out-of-pocket (OOP) expenses trigger financial hardship remain under-investigated. We assessed national trends in the incidence of catastrophic health expenditure (CHE) among U.S. older adults with dementia and the OOP drivers to identify specific service types contributing to financial vulnerability.
METHODS: We analyzed 2012-2021 Medical Expenditure Panel Survey data for adults aged ≥ 65 years with dementia, identified via ICD-9 and ICD-10 codes. CHE was defined as OOP spending exceeding 40% of household capacity-to-pay. Annual OOP spending was decomposed into: inpatient hospitalization, office-based visits, emergency room visits, prescription medicines, home health services, and health insurance premiums.
RESULTS: From 2012 to 2021, annual CHE incidence exceeded 50% in the majority of the study period. For households experiencing CHE in 2021, total annual OOP spending reached $6,228.1, a 108.5% increase from the 2013 low of $2,987.4. Home health services were the primary driver, with 2021 OOP costs at $3,401.6, following a 2020 peak of $5,062.8. In 2021, insurance premiums and prescription medicines accounted for $762.0 and $333.2, respectively. Notably, 2021 home health OOP costs were 10.2 times higher than prescription medicine costs for those facing catastrophic strain. Office-based OOP spending peaked at $3,152.9 in 2018, while inpatient costs peaked at $1,275.5 in 2016.
CONCLUSIONS: Older adults with dementia face high risks of catastrophic financial burden, driven primarily by home health services and insurance premiums rather than acute care. Policies should prioritize long-term home-based care coverage and premium affordability to prevent financial ruin.
METHODS: We analyzed 2012-2021 Medical Expenditure Panel Survey data for adults aged ≥ 65 years with dementia, identified via ICD-9 and ICD-10 codes. CHE was defined as OOP spending exceeding 40% of household capacity-to-pay. Annual OOP spending was decomposed into: inpatient hospitalization, office-based visits, emergency room visits, prescription medicines, home health services, and health insurance premiums.
RESULTS: From 2012 to 2021, annual CHE incidence exceeded 50% in the majority of the study period. For households experiencing CHE in 2021, total annual OOP spending reached $6,228.1, a 108.5% increase from the 2013 low of $2,987.4. Home health services were the primary driver, with 2021 OOP costs at $3,401.6, following a 2020 peak of $5,062.8. In 2021, insurance premiums and prescription medicines accounted for $762.0 and $333.2, respectively. Notably, 2021 home health OOP costs were 10.2 times higher than prescription medicine costs for those facing catastrophic strain. Office-based OOP spending peaked at $3,152.9 in 2018, while inpatient costs peaked at $1,275.5 in 2016.
CONCLUSIONS: Older adults with dementia face high risks of catastrophic financial burden, driven primarily by home health services and insurance premiums rather than acute care. Policies should prioritize long-term home-based care coverage and premium affordability to prevent financial ruin.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE457
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies, Work & Home Productivity - Indirect Costs
Disease
SDC: Geriatrics, SDC: Neurological Disorders