Impact of Spousal Death on Healthcare Costs and Use Among Medicare Beneficiaries: NHATS 2011-2017.

Lei L, Norton EC, Strominger J, Maust DT. Impact of Spousal Death on Healthcare Costs and Use Among Medicare Beneficiaries: NHATS 2011-2017. Journal of general internal medicine. 2022 Aug 1; 37(10):2514-2520.

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Abstract:

BACKGROUND: Spousal death is associated with elevated mortality in the surviving partner; less is known about how healthcare costs and use change following spousal death. OBJECTIVES: To examine the causal impact of spousal death on Medicare costs and use over time. DESIGN: Longitudinal cohort study with an event study design. SETTING: National Health and Aging Trends Study (NHATS) with linked Medicare claims. PARTICIPANTS: Respondents from 2011-2017 who reported spousal death the prior year, limited to those with traditional Medicare (n = 491 with 9,766 respondent-quarters). MAIN MEASURES: Total Medicare costs; binary indicators for acute hospitalization; emergency department; sub-acute care (including skilled nursing, rehabilitation, and long-term care); and number of outpatient management visits on a quarterly basis 3 years before and after spousal death. KEY RESULTS: During the first year post-death, quarterly Medicare costs for the surviving spouse were $1,092 higher than pre-death; probability of hospitalization, emergency department, and sub-acute care were 3.3%, 2.8%, and 2.2% higher, respectively; and there were 0.3 more outpatient visits (p < .01 for all). Several outcomes continued to be elevated during the second year, including costs ($1,174 higher per quarter), hospitalization (3.2% higher), and sub-acute care (2.9% higher; p < .01 for all). By the third year, costs returned to pre-death level but hospitalization and sub-acute care (2.9% and 3.1% higher per quarter; p < .05 for both) remained elevated. Cost increases in the first and second years post-death were larger if the deceased spouse was a caregiver ($1,588 and $1,853 per quarter) or female (i.e., among bereaved males; $1,457 and $1,632 per quarter; p < .05 for all). CONCLUSIONS: Spousal death increased total Medicare costs and use of all healthcare categories among the surviving partner; elevations in hospitalization and sub-acute care persisted through the third year. Clinicians and payors may want to target surviving partners as a high-risk population.