Abstract
BackgroundIn ageing populations, informal care holds great potential to limit rising health care expenditure. The majority of informal care is delivered by spouses. The loss of informal care due to the death of the spouse could therefore increase expenditure levels for formal care.ObjectiveTo investigate the impact of the death of the spouse on health care expenditure by older people through time. Additionally, to examine whether the impact differs between socio-demographic groups, and what health services are affected most.DesignLongitudinal data on health care expenditure (from July 2007 through 2010) from a regional Dutch health care insurer was matched with data on marital status (2004–2011) from the Central Bureau of Statistics. Linear mixed models with log transformed health care expenditure, generalized linear models and two-part models were used to retrieve standardized levels of monthly health care expenditure of 6,487 older widowed subjects in the 42 months before and after the loss of the spouse.ResultsMean monthly health care expenditure in married subjects was €502 in the 42 months before the death of the spouse, and expenditure levels rose by €239 (48%) in the 42 months after the death of the spouse. The increase in expenditure after the death of the spouse was highest for men (€319; 59%) and the oldest old (€553; 82%). Expenditure levels showed the highest increase for hospital and home care services (together €166).ConclusionsThe loss of the spouse is associated with an increase in health care expenditure. The relatively high rise in long-term care expenses suggests that the loss of informal care is an important determinant of this rise.
Highlights
In many developed countries, population ageing can be directly related to a rise in health care expenditure
We analysed the effects of socio-demographic characteristics on health care expenditure (HCE) in the total population (n561,495)
The death of the spouse impacts the level of health care expenditure of an older person
Summary
Population ageing can be directly related to a rise in health care expenditure. Higher levels of health care expenditure are associated with old age, older people hold potential to limit expenditure levels. Older people keep their partners, family-members, friends or neighbours away from the health care sector. Several authors have found that having a partner significantly decreases older people’s risk of utilizing nursing home services [5,6,7,8,9] These studies do not include expenditure levels and often do not look at the use of other health care services. Informal care holds great potential to limit rising health care expenditure. The loss of informal care due to the death of the spouse could increase expenditure levels for formal care. The relatively high rise in long-term care expenses suggests that the loss of informal care is an important determinant of this rise
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