An Examination of Downstream Effects of Bereavement on Healthcare Utilization for Surviving Spouses in a National Sample of Older Adults
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While bereavement is associated with increased mortality, it is unclear how bereaved families utilize the healthcare system after the death of their loved ones.
The aim of this study was to examine the association between bereavement and healthcare expenditures for surviving spouses.
We used data from the Health and Retirement Study, a nationally representative cohort study of older adults linked to Medicare claims. We determined a spouse’s total Medicare expenditures 2 years before and after their partner’s death across six biennial interview waves. Using coarsened exact matching, we created a comparison group of non-bereaved dyads. Costs were wage index- and inflation-adjusted to 2017 dollars. We used generalized linear models and difference-in-differences (DID) analysis to calculate the average marginal effects of bereavement on Medicare spending by gender. We also examined subgroup differences based on caregiver status, cause of death, and length of terminal illness.
Our sample consisted of 941 bereaved dyads and a comparison group of 8899 matched dyads. Surviving female spouses (68% of the sample) had a $3500 increase in spending 2 years after death (p < 0.05). Using DID analyses, bereavement was associated with a $625 quarterly increase in Medicare expenditures over 2 years for women. There was no significant increase in post-death spending for male bereaved surviving spouses. Results were consistent for spouses who survived at least 2 years after the death of their spouse (70% of the sample)
Bereavement is associated with increased healthcare spending for women regardless of their caregiving status, the cause of death, or length of terminal illness. Further study is required to examine why men and women have different patterns of healthcare spending relative to the death of their spouses.
KO and AK developed the research question, and KO, MG, O-KR and EB-L developed the research methodology and conducted the analyses. All authors contributed to the writing of the manuscript.
Compliance with Ethical Standards
Conflict of interest
Katherine Ornstein, Melissa Garrido, Albert Siu, Evan Bollens-Lund, Omari-Khalid Rahman, and Amy Kelley have no financial conflicts of interest to declare.
The HRS is funded by the National Institute of Aging (NIA) [NIA U01 AG009740] and the Social Security Administration. The study investigators were supported by the National Institute on Aging (Grant Numbers K01AG047923 [Dr. Ornstein] and R01AG054540 [Dr. Kelley]), and VA HSR&D 16-140 (Dr. Garrido). The funding sources had no role in the design, conduct, and analysis of this study or in the decision to submit the manuscript for publication. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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