the impact of health expenses on older women ’ s financial security juliette cubanski, ph.d. the...

The Impact of Health Expenses The Impact of Health Expenses on Older Women’s Financial on Older Women’s Financial

SecuritySecurityJuliette Cubanski, Ph.D.Juliette Cubanski, Ph.D.

The Henry J. Kaiser Family FoundationThe Henry J. Kaiser Family Foundation

AcademyHealth AcademyHealth 2007 Annual Research Meeting2007 Annual Research Meeting

Orlando, FloridaOrlando, Florida

3 June 20073 June 2007

Exhibit 2

ResearchResearch Questions Questions

What are the key differences in health status What are the key differences in health status and utilization of medical and long-term care and utilization of medical and long-term care services between women and men age 65+?services between women and men age 65+?

What sources of insurance coverage do older What sources of insurance coverage do older women rely on, and how does this compare to women rely on, and how does this compare to older men?older men?

How much do older women and men spend on How much do older women and men spend on health care and what is the distribution of health care and what is the distribution of spending for various services?spending for various services?

What is the burden of out-of-pocket health care What is the burden of out-of-pocket health care spending as a share of income among older spending as a share of income among older women, and how does it compare among women, and how does it compare among various subgroups?various subgroups?

Exhibit 3

Women’s Economic & Demographic RealityWomen’s Economic & Demographic Reality

Working-age women have lower incomes than Working-age women have lower incomes than menmen Wage disparity and lower workforce participationWage disparity and lower workforce participation

Women accumulate fewer assets for retirement Women accumulate fewer assets for retirement than menthan men Lower workforce participation affects social security Lower workforce participation affects social security

payments, retiree benefits and income (pensions, payments, retiree benefits and income (pensions, IRAs)IRAs)

Women have longer lifespans than menWomen have longer lifespans than men At age 65, women are expected to live another 20 At age 65, women are expected to live another 20

years, compared to 17 for menyears, compared to 17 for men

Women have more long-term care needs than Women have more long-term care needs than menmen

Exhibit 4

Data and MethodsData and Methods

Analyzed 2002 Medicare Current Beneficiary Survey Cost Analyzed 2002 Medicare Current Beneficiary Survey Cost and Use fileand Use file Sample population included 6,195 women and 4,396 men age Sample population included 6,195 women and 4,396 men age

65 years or older living either in the community or in a facility65 years or older living either in the community or in a facility

Compared women and men age 65+ on Medicare to assess Compared women and men age 65+ on Medicare to assess key differences in age, income, marital status, insurance key differences in age, income, marital status, insurance coverage, health status, and utilization of medical and long-coverage, health status, and utilization of medical and long-term care (LTC) servicesterm care (LTC) services

Examined out-of-pocket spending on health care by Examined out-of-pocket spending on health care by aggregating spending on Medicare Parts A and B, aggregating spending on Medicare Parts A and B, supplemental insurance premiums, and all reported medical supplemental insurance premiums, and all reported medical and LTC servicesand LTC services

Estimated the burden of out-of-pocket health care spending Estimated the burden of out-of-pocket health care spending among women and men age 65+ by calculating the ratio of among women and men age 65+ by calculating the ratio of annual out-of-pocket spending on medical care to annual annual out-of-pocket spending on medical care to annual incomeincome

Exhibit 5

Key Demographic, Economic, and Health Status Key Demographic, Economic, and Health Status Indicators of Medicare Beneficiaries Age 65+, 2002Indicators of Medicare Beneficiaries Age 65+, 2002

Women 65+ Women 65+ (20.8 million)(20.8 million)

Men 65+ Men 65+ (15.1 million)(15.1 million)

Average ageAverage age 76.1 years76.1 years 74.7 years74.7 years

Percent age 85+Percent age 85+ 16%16% 10%10%

Lives aloneLives alone 41%41% 19%19%

Among 85+, lives aloneAmong 85+, lives alone 59%59% 32%32%

Lives in long-term care facilityLives in long-term care facility 6%6% 3%3%

Among 85+, lives in long-term care Among 85+, lives in long-term care facilityfacility 21%21% 11%11%

Average annual incomeAverage annual income $25,921$25,921 $36,161$36,161

Percent with income less than $20,000Percent with income less than $20,000 56%56% 37%37%

Fair/poor health statusFair/poor health status 26%26% 23%23%

Two or more chronic conditionsTwo or more chronic conditions 65%65% 53%53%

Cognitive/mental impairmentCognitive/mental impairment 21%21% 17%17%

Two or more limitations in activities of daily Two or more limitations in activities of daily livingliving 16%16% 12%12%

Number of home health visits*Number of home health visits* 122 visits122 visits 91 visits91 visits

Number of prescription drug fills*Number of prescription drug fills* 3131 2525NOTE: Health status indicators exclude the institutionalized population. * Utilization among beneficiaries with reported use NOTE: Health status indicators exclude the institutionalized population. * Utilization among beneficiaries with reported use of service.of service.SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2002 Cost and Use File.SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2002 Cost and Use File.

Exhibit 6

Health Insurance Coverage Among Medicare Health Insurance Coverage Among Medicare Beneficiaries Age 65+, by Sex, 2002Beneficiaries Age 65+, by Sex, 2002

6% 9%

15% 9%

15%

30%28%

32% 37%

2%1%

16%

Employer-sponsored

Self-purchased

Medicare HMO

Medicaid/ QMB

None

Other

SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2002 Cost and Use File.SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2002 Cost and Use File.

Men 65+Women 65+

Exhibit 7

6%4%13%14%

21%16%

17% 30%

43%

36%

Premiums

Long-term care:nursing home; SNF;home health Medical/ dental visits;supplies

Prescription drugs

Inpatient/ outpatienthospital visits

NOTE: Estimates reflect mean out-of-pocket spending for Medicare and private insurance premiums and health care NOTE: Estimates reflect mean out-of-pocket spending for Medicare and private insurance premiums and health care services. services. SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2002 Cost and Use File.SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2002 Cost and Use File.

Women 65+Women 65+

Total OOP = $83 billionTotal OOP = $83 billion

Men 65+Men 65+

Total OOP = $49 billionTotal OOP = $49 billion

$3,991$3,991

$3,269$3,269

Distribution of Mean Out-of-Pocket Health Distribution of Mean Out-of-Pocket Health Spending by Medicare Beneficiaries Age 65+, Spending by Medicare Beneficiaries Age 65+,

20022002

$1,450

$1,407

$557

$671

$428$206

$1,210

$634

$546$152

Exhibit 8Mean and Median Out-of-Pocket Spending Mean and Median Out-of-Pocket Spending by Women on Medicare Age 65+, by Age, by Women on Medicare Age 65+, by Age,

20022002

NOTE: Estimates include out-of-pocket spending for Medicare and private insurance premiums and health care services.NOTE: Estimates include out-of-pocket spending for Medicare and private insurance premiums and health care services.SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2002 Cost and Use file.SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2002 Cost and Use file.

$3,991

$2,970

$4,114

$6,699

$2,595 $2,803$3,133

$2,312

Total 65-74 75-84 85+

MEANMEAN

MEDIAMEDIANN

Exhibit 9

Out-of-Pocket Spending by Women on Out-of-Pocket Spending by Women on Medicare Age 65+, by Age, 2002Medicare Age 65+, by Age, 2002

NOTE: Estimates include out-of-pocket spending for Medicare and private insurance premiums and health care services.NOTE: Estimates include out-of-pocket spending for Medicare and private insurance premiums and health care services.SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2002 Cost and Use file.SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2002 Cost and Use file.

$2,595

$2,312

$2,803

$3,133

Total 65-74 75-84 85+

14%

19%

23%

17%

Total 65-74 75-84 85+

Median Out-of-Pocket Spending Median Out-of-Pocket Spending As Percent of IncomeAs Percent of Income

Median Out-of-Pocket SpendingMedian Out-of-Pocket Spending

Men Men 65+: 65+: 14%14%

Exhibit 10

$2,499

$846

$1,968

$2,502

$3,501

None Medicaid/ QMB

MedicareHMO

Employer-sponsored

Self-purchased

Out-of-Pocket Spending by Women on Out-of-Pocket Spending by Women on Medicare Age 65+, by Insurance Coverage, Medicare Age 65+, by Insurance Coverage,

20022002

11%

14% 14%

24%

18%

8%

5% 5%

8%

25%

None Medicaid/ QMB

MedicareHMO

Employer-sponsored

Self-purchased

NOTE: Estimates include out-of-pocket spending for Medicare and private insurance premiums and health care services. NOTE: Estimates include out-of-pocket spending for Medicare and private insurance premiums and health care services. SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2002 Cost and Use file.SOURCE: Kaiser Family Foundation analysis of the Medicare Current Beneficiary Survey 2002 Cost and Use file.

Median Out-of-Pocket SpendingMedian Out-of-Pocket SpendingMedian Out-of-Pocket Spending Median Out-of-Pocket Spending

As Percent of Income As Percent of Income (Total incl. Premiums/Health Care Services (Total incl. Premiums/Health Care Services

Only) Only)

Exhibit 11

Out-of-Pocket Spending by Women on Out-of-Pocket Spending by Women on Medicare Age 65+, by Race/Ethnicity, 2002Medicare Age 65+, by Race/Ethnicity, 2002

13%15%

18%

White AfricanAmerican

Hispanic


$2,825

$1,533$1,437

White AfricanAmerican

Hispanic



Exhibit 12

Out-of-Pocket Spending by Women on Out-of-Pocket Spending by Women on Medicare Age 65+, by Income, 2002Medicare Age 65+, by Income, 2002

22%

16%

13%

8%

26%

$10,000or less

$10,001-$20,000

$20,001-$30,000

$30,001-$40,000

$40,000or more


$1,614

$2,615$2,821

$3,002 $2,927

$10,000or less

$10,001-$20,000

$20,001-$30,000

$30,001-$40,000

$40,000or more



Exhibit 13

Key Findings and ImplicationsKey Findings and Implications

Older women have greater health care needs Older women have greater health care needs and lower incomes than older menand lower incomes than older men

Long-term care use and spending are key Long-term care use and spending are key differences between elderly women and men differences between elderly women and men

Older women spend more out-of-pocket on Older women spend more out-of-pocket on health care than older men, both in dollars and health care than older men, both in dollars and as a share of their incomesas a share of their incomes

Pressure to control costs in the private and Pressure to control costs in the private and public health insurance sectors could public health insurance sectors could disproportionately impact older womendisproportionately impact older women

the impact of health expenses on older women ’ s financial security juliette cubanski, ph.d. the...

Documents