Alzheimer Disease and Related Disorders and Out-of-Pocket Health Care Spending and Burden among Elderly Medicare Beneficiaries

Nilanjana Dwibedi, Patricia A. Findley, Constance R. Wiener, Chan Shen, Usha Sambamoorthi

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Objective: To estimate the excess burden of out-of-pocket health care spending associated with Alzheimer disease and related disorders (ADRD) among older individuals (age 65 y and older). Methods: We adopted a retrospective, cross-sectional study design with data from 2012 Medicare Current Beneficiary Survey. The study sample comprised of elderly community-dwelling individuals who had positive total health care expenditures, and enrolled in Medicare throughout the calendar year (462 with ADRD, and 7160 without ADRD). We estimated the per-capita total annual out-of-pocket spending on health care and out-of-pocket spending by service type: Inpatient, outpatient, home health, prescription drugs, and other services. We measured out-of-pocket spending burden by calculating the percentage of income spent on health care and defined high out-of-pocket spending burden as having this percentage above 10%. Multivariable analyses included ordinary least squares regressions and logistic regressions and these analyses adjusted for predisposing, enabling, need, personal health care practices and external environment characteristics. Results: The average annual per-capita out-of-pocket health care spending was greater among individuals with ADRD compared with those without ADRD ($3285 vs. $1895); home health and prescription drugs accounted for 52% of total out-of-pocket spending among individuals with ADRD and 34% among individuals without ADRD. Elderly individuals with ADRD were more likely to have high out-of-pocket spending burden (adjusted odds ratio, 1.49; 95% confidence interval, 1.13-1.97) compared with those without ADRD. Conclusion: ADRD is associated with excess out-of-pocket health care spending, primarily driven by prescription drugs and home health care use.

Original languageEnglish (US)
Pages (from-to)240-246
Number of pages7
JournalMedical care
Issue number3
StatePublished - 2018

All Science Journal Classification (ASJC) codes

  • Public Health, Environmental and Occupational Health


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