Dataset Information

Distribution of lifetime nursing home use and of out-of-pocket spending.

ABSTRACT: Reliable estimates of the lifetime risk of using a nursing home and the associated out-of-pocket costs are important for the saving decisions by individuals and families, and for the purchase of long-term care insurance. We used data on up to 18 y of nursing home use and out-of-pocket costs drawn from the Health and Retirement Study, a longitudinal household survey representative of the older US population. We accumulated the use and spending by individuals over many years, and we developed and used an individual-level matching method to account for use before and after the observation period. In addition, for forecasting, we estimated a dynamic parametric model of nursing home use and spending. We found that 56% of persons aged 57-61 will stay at least one night in a nursing home during their lifetimes, but only 32% of the cohort will pay anything out of pocket. Averaged over all persons, total out-of-pocket expenditures looking forward from age 57 were approximately $7,300, discounted at 3% per year. However, the 95th percentile of spending was almost $47,000. We conclude that the percentage of people ever staying in nursing homes is substantially higher than previous estimates, at least partly due to an increase in nursing home episodes of short duration. Average lifetime out-of-pocket costs may be affordable, but some people will incur much higher costs.

SUBMITTER: Hurd MD

PROVIDER: S-EPMC5603996 | biostudies-literature | 2017 Sep

REPOSITORIES: biostudies-literature

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Distribution of lifetime nursing home use and of out-of-pocket spending.

Hurd Michael D MD Michaud Pierre-Carl PC Rohwedder Susann S

Proceedings of the National Academy of Sciences of the United States of America 20170828 37

Reliable estimates of the lifetime risk of using a nursing home and the associated out-of-pocket costs are important for the saving decisions by individuals and families, and for the purchase of long-term care insurance. We used data on up to 18 y of nursing home use and out-of-pocket costs drawn from the Health and Retirement Study, a longitudinal household survey representative of the older US population. We accumulated the use and spending by individuals over many years, and we developed and ...[more]

PMID: 28847934

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Project description:ImportanceBy 2020, nearly all states had adopted oncology parity laws in the US, ensuring that patients in fully insured private health plans pay no more for orally administered anticancer medications (OAMs) than infused therapies. Between 2013 and mid-2017, 11 states implemented parity with out-of-pocket spending caps, which may further reduce patient out-of-pocket spending.ObjectiveTo compare OAM uptake and out-of-pocket and health plan spending on OAMs in states with parity with and without spending caps, as well as to assess out-of-pocket spending for caps that apply predeductible vs postdeductible.Design setting and participantsThis cohort study analyzed OAM users enrolled in commercial health plans offered by Aetna, Humana, and United Healthcare in the US from 2011 to 2017, aggregated by the Health Care Cost Institute, using difference-in-difference-in-differences (DDD) analysis. Data analysis was conducted between June and August 2020.ExposuresTime (before vs after parity), whether the state parity law included an out-of-pocket spending cap, and whether the plan was fully insured (subject to parity) or self-funded (not subject to parity). Among states with caps, out-of-pocket spending was also compared by whether the cap was applied predeductible and postdeductible vs only postdeductible.Main outcomes and measuresMonthly OAM prescription fills per 100 000 enrollees, per-OAM prescription-fill out-of-pocket spending, and annual per-user health plan spending on OAMs.ResultsIn this study of 23 states (11 with caps and 12 without) and 207 579 OAM prescription fills, caps were associated with a modest increase in OAM use (DDD, 7.40 [95% CI, 3.41-11.39] per 100 000 enrollees). There was no difference in mean out-of-pocket spending comparing fully insured and self-funded enrollees in states with vs without caps (DDD, -$17 [95% CI, -$57 to $24), but caps were associated with lower spending among OAM users in the 95th percentile of out-of-pocket spending by $831 (95% CI, -$871 to -$791) per OAM prescription fill. Caps applied predeductible were associated with greater out-of-pocket savings relative to caps applied only postdeductible. This included per-OAM prescription-fill savings at the 75th, 90th, and 95th percentiles. Postparity, mean annual spending on OAMs among users was $113 589 in states without caps and $102 252 in states with caps, with no differences between groups (DDD, $9799 [95% CI, -$4230 to $23 829).Conclusions and relevanceIn this cohort study, among states adopting oncology parity laws between 2013 and 2017, mean out-of-pocket spending per OAM prescription fill and mean health plan spending among OAM users was similar in states with and without caps. However, enrollees in states with parity plus out-of-pocket caps had greater reductions in out-of-pocket spending among the highest spenders. Caps may offer improved financial protection for the highest spenders without increasing mean health plan spending on OAMs.

Project description:In this study, we analyzed healthcare provision and health expenditure across six Mediterranean countries that adopt the National Health System (Beveridge model) and that form part of the European Union (EU) with the main aim being that of analyzing and comparing out-of-pocket health spending in countries with a European Mediterranean connection. To this end, we considered various economic indicators and statistics to derive commonalities and differences across these countries and also compared trends in these indicators to those observed across the rest of the EU. We then analyzed these findings in light of other data related to the quality of healthcare delivery and the infrastructure of the health system and discussed recent developments in healthcare within each country and the main challenges faced by the respective health systems. The results show that on average, Mediterranean countries spend less on total healthcare expenditure (THE) than the EU average, both as a proportion of GDP, as well as in per capita terms. This is primarily driven by lower-than-EU-average public funding of healthcare. The 2008/2009 macro-economic and financial crisis had a significant impact on the countries under review, and explains the persistent reductions in public health spending as part of the austerity measures put in force across sectors. On the flipside, Mediterranean countries have a higher presence of private health providers in total funding, thereby explaining the higher Out-of-Pocket (OOPs) health expenditures in these countries relative to the EU-average. With regard to the overall health infrastructure in these countries, we observed that although the supply of physicians is largely in line with the rest of the EU, there is under-supply when it comes to hospital beds. This may be symptomatic of lower government funding. Nonetheless, all countries score highly in the evaluation of the quality of health services, as recorded by international rankings like the WHO's 2000 metric, whereas health system performance indicators, namely mortality rates and life expectancy reveal favorable health outcomes in the Mediterranean EU countries. The findings in this paper may be seen in light of the Mediterranean region's lifestyle in terms of diet, health behavior, health beliefs and shared culture. In particular, the higher out-of-pocket expenditure may reflect the tendency for one-to-one relationships with private clinicians and the pursuit of person-centered care (1). Additionally, the Mediterranean people may not be as disciplined as their European counterparts in accessing and using the public health sector. The lower THE also reflects the fact that the Mediterranean countries are less wealthy than the more economically-advanced European countries.

Project description:BACKGROUND:With total and out-of-pocket spending for oral oncolytics rising, there is increased interest in choosing oncology treatments based on their clinical value relative to cost. OBJECTIVE:To determine if out-of-pocket spending varied for higher versus lower benefit oral oncology drugs reimbursed by commercial insurers. METHODS:This study was a retrospective analysis of commercial insurer prescription drug claims filed between 2007 and 2014 for 13 oral oncolytics approved before 2009. We calculated mean monthly out-of-pocket payment for each fill by patient. We then categorized oral oncolytics by their overall and progression-free survival benefits for each FDA-approved indication, using evidence from published studies. We assessed the relationship of survival benefit with mean monthly out-of-pocket payment, adjusting for demographic and plan characteristics. RESULTS:Our population included 44,113 patients aged 18-65 years (mean 52.5 [SD 9.4]) with a cancer diagnosis who filled 731,354 prescriptions. The most commonly represented oncolytics were imatinib (37.4% of fills), lenalidomide (17.7% of fills), and dasatinib (10.0% of fills). Approximately 32.3% of fills were for drug-indication pairs with an overall survival benefit of 4+ years. In adjusted analyses, there was no clear pattern to suggest that out-of-pocket payments differed with drug indication-specific survival benefits. Drugs for indications providing > 0 to 1 year of overall survival benefit were significantly more likely to have a lower out-of-pocket payment versus those prescribed off-label, but there were no significant differences in out-of-pocket payments between drugs and associated indications in any other survival category versus drugs used off-label. CONCLUSIONS:Out-of-pocket payments for oral oncolytics were not clearly related to indication-specific value in commercially insured patients. This finding suggests that despite increased attention to value- and indication-based drug pricing, cost sharing for oral oncolytics does not currently reflect these goals. DISCLOSURES:This project was supported by Research Scholar Grant RSGI-14-030-01-CPHPS from the American Cancer Society; the NIH Building Interdisciplinary Research Careers in Women's Health (BIRCWH) K12 Program; the North Carolina Translational and Clinical Sciences Institute (UL1TR001111) Grant; and K24CA181510 from the National Cancer Institute. The authors have no disclosures. Data from this study were presented at the 2017 American Society for Clinical Oncology Annual Meeting on June 5, 2017, in Chicago, Illinois.

Project description:ObjectivesMany patients report financial stress following hospitalization for COVID-19. Although many COVID-19 survivors require extensive care after discharge, the degree to which this care contributes to financial stress is unclear. Using national data, we assessed out-of-pocket spending during the 180 days after discharge among patients hospitalized for COVID-19.Study designRetrospective cohort analysis of Optum's deidentified Clinformatics Data Mart, a national database of medical and pharmacy claims.MethodsAmong privately insured and Medicare Advantage patients hospitalized for COVID-19 between March and June 2020, we calculated median out-of-pocket spending during the 180 days after discharge. For comparison, we repeated this calculation among patients hospitalized for pneumonia.ResultsOf 7932 patients with COVID-19 included in analyses, 2061 (26.0%) had private insurance. Among privately insured and Medicare Advantage patients, median (25th-75th percentile) out-of-pocket spending after discharge was $287 ($59-$842) and $271 ($63-$783), respectively. Out-of-pocket spending exceeded $2000 for 10.9% and 9.3% of these patients, respectively. Among privately insured and Medicare Advantage patients hospitalized for pneumonia, median (25th-75th percentile) out-of-pocket spending after discharge was $276 ($62-$836) and $570 ($181-$1466). Out-of-pocket spending exceeded $2000 for 12.1% and 17.2% of these patients, respectively.ConclusionsFor most patients hospitalized for COVID-19, postdischarge care may not be a major source of financial stress. Although this is reassuring, our findings also suggest that a sizable minority of COVID-19 survivors have substantial out-of-pocket spending after discharge. These survivors could be particularly vulnerable to financial toxicity if they also receive bills for the hospitalization owing to the expiration of insurer cost-sharing waivers. Insurers should consider this possibility when deciding whether to reinstate cost-sharing waivers for COVID-19 hospitalizations.

Project description:ImportanceRising out-of-pocket costs of maternal health care for people with commercial insurance may affect use of health care and outcomes. There are stark racial and ethnic disparities in outcomes, but little is known about differences in spending.ObjectiveTo measure differences in out-of-pocket spending for maternity care by race and ethnicity.Design, setting, and participantsThis retrospective cross-sectional study used administrative data from Blue Cross Blue Shield of Massachusetts from January 1, 2018, through December 31, 2022, for pregnancies, deliveries, and 42-day postpartum care. Participants were continuously enrolled during pregnancy, delivery, and 42 days post partum (collectively termed maternity episode).ExposuresThe primary characteristic of interest was the birthing person's race and ethnicity.Main outcomes and measuresThe primary outcome was total out-of-pocket spending during the maternity episode. Out-of-pocket spending was measured separately for the pregnancy period, prenatal services, and delivery, by type of cost sharing, and as a percentage of the median household income in the patient's census tract (using American Community Survey data). Race and ethnicity were measured via self-report and imputation.ResultsThe analytic sample included 87 253 maternity episodes among 76 826 unique birthing persons (mean [SD] age, 32.4 [4.7] years; 99.8% female) between 2018 and 2022; among maternity episodes, 8572 birthing persons (9.8%) were Asian, 3331 (3.8%) were Black, 6872 (7.9%) were Hispanic, and 68 478 (78.5%) were White. Mean out-of-pocket spending for the maternity episode was highest among Black birthing people ($2398 [$426]), followed by Hispanic ($2300 [$572]), Asian ($2202 [$603]), and White ($2036 [$1547]) birthing people (P < .001). These differences remained statistically significant after adjusting for health and demographic characteristics. The differences were largest in the prenatal period and for coinsurance payments. Black (1003 [30.1%]) and Hispanic (2302 [33.5%]) birthing people were more likely than Asian (1569 [18.3%]) and White (12 600 [18.4%]) birthing people to be enrolled in plans with high coinsurance, but not plans with high deductibles (3317 [38.7%] for Asian, 1232 [37.0%] for Black, 2350 [34.2%] for Hispanic, and 24 515 [35.8%] for White birthing people).Conclusions and relevanceIn this study, differences in out-of-pocket maternity spending among the commercially insured were associated with differences in coinsurance rates. These costs could lead people to forgo needed health care or other basic needs that support health (eg, food or housing). Changes to health plan benefit design could improve equity in out-of-pocket maternity spending and its consequences.

Dataset Information

Distribution of lifetime nursing home use and of out-of-pocket spending.

Publications

Distribution of lifetime nursing home use and of out-of-pocket spending.

Similar Datasets

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