Changes in health care expenditure after the loss of a spouse: Data on 6,487 older widows and widowers in the Netherlands

Herbert J A Rolden; David van Bodegom; Rudi G J Westendorp

doi:10.1371/journal.pone.0115478

Changes in health care expenditure after the loss of a spouse: Data on 6,487 older widows and widowers in the Netherlands

Herbert J A Rolden
, David van Bodegom
, Rudi G J Westendorp

Leyden Academy on Vitality and Ageing
Leiden University Medical Center, Department of Gerontology and Geriatric

Onderzoeksoutput: Article › Academic › peer review

Samenvatting

Achtergrond: Bij een vergrijzende bevolking biedt informele zorg een groot potentieel om de stijgende uitgaven voor gezondheidszorg te beperken. De meeste informele zorg wordt verleend door echtgenoten. Het verlies van informele zorg door het overlijden van de echtgeno(o)t(e) zou daarom de uitgaven voor formele zorg kunnen verhogen.
Doelstelling: Het onderzoeken van de impact van het overlijden van de echtgeno(o)t(e) op de uitgaven voor gezondheidszorg door ouderen door de tijd heen. Daarnaast onderzoeken of de impact verschilt tussen socio-demografische groepen, en welke gezondheidsdiensten het meest beïnvloed worden.
Opzet: Longitudinale gegevens over zorguitgaven (van juli 2007 tot en met 2010) van een regionale Nederlandse zorgverzekeraar werden gematcht met gegevens over burgerlijke staat (2004-2011) van het Centraal Bureau voor de Statistiek. Lineaire gemengde modellen met log getransformeerde zorguitgaven, gegeneraliseerde lineaire modellen en tweedelige modellen werden gebruikt om gestandaardiseerde niveaus van maandelijkse zorguitgaven van 6.487 oudere weduwnaars te achterhalen in de 42 maanden voor en na het verlies van de echtgeno(o)t(e).
Resultaten: De gemiddelde maandelijkse uitgaven aan gezondheidszorg bij getrouwde personen bedroegen €502 in de 42 maanden voor het overlijden van de echtgenoot, en het uitgavenniveau steeg met €239 (48%) in de 42 maanden na het overlijden van de echtgenoot. De stijging van de uitgaven na het overlijden van de echtgenoot was het hoogst voor mannen (€319; 59%) en de oudste ouderen (€553; 82%). Uitgavenniveaus lieten de hoogste stijging zien voor ziekenhuis- en thuiszorgdiensten (samen €166).
Conclusies: Het verlies van de echtgenoot gaat gepaard met een stijging van de uitgaven voor gezondheidszorg. De relatief hoge stijging van de uitgaven voor langdurige zorg suggereert dat het verlies van informele zorg een belangrijke determinant is van deze stijging.

Originele taal-2	English
Artikelnummer	e115478
Aantal pagina's	17
Tijdschrift	PLOS ONE
Volume	9
Nummer van het tijdschrift	12
DOI's	https://doi.org/10.1371/journal.pone.0115478
Status	Published - 23 dec. 2014
Extern gepubliceerd	Ja

Keywords

ouderen
80 jaar en ouder
dood
demografie
vrouwelijk
gezondheidsuitgaven
mannelijk
middelbare leeftijd
epidemiologie
Nederland
socio-economische factoren
echtgenoten
weduwschap
weduweschap
statistieken en numerieke gegevens

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@article{3b46b0f36f234d548cdbe628155ff831,

title = "Changes in health care expenditure after the loss of a spouse: Data on 6,487 older widows and widowers in the Netherlands",

abstract = "Background: In ageing populations, informal care holds great potential to limit rising health care expenditure. The majority of informal care is delivered by spouses. The loss of informal care due to the death of the spouse could therefore increase expenditure levels for formal care. Objective: To investigate the impact of the death of the spouse on health care expenditure by older people through time. Additionally, to examine whether the impact differs between socio-demographic groups, and what health services are affectedmost. Design: Longitudinal data on health care expenditure (from July 2007 through 2010) from a regional Dutch health care insurer was matched with data on marital status (2004-2011) from the Central Bureau of Statistics. Linear mixed models with log transformed health care expenditure, generalized linear models and two-part models were used to retrieve standardized levels of monthly health care expenditure of 6,487 older widowed subjects in the 42 months before and after the loss of the spouse. Results: Mean monthly health care expenditure in married subjects was J502 in the 42 months before the death of the spouse, and expenditure levels rose by J239 (48\%) in the 42 months after the death of the spouse. The increase in expenditure after the death of the spouse was highest for men (J319; 59\%) and the oldest old (J553; 82\%). Expenditure levels showed the highest increase for hospital and home care services (together J166). Conclusions: The loss of the spouse is associated with an increase in health care expenditure. The relatively high rise in long-term care expenses suggests that the loss of informal care is an important determinant of this rise.",

keywords = "aged, aged 80 and over, death, demography, female, health expenditure, male, middle aged, epidemiology, Netherlands, socioeconomic factors, spouses, widowhood, statistics \& numerical data, spousal support, older adults, ouderen, 80 jaar en ouder, dood, demografie, vrouwelijk, gezondheidsuitgaven, mannelijk, middelbare leeftijd, epidemiologie, Nederland, socio-economische factoren, echtgenoten, weduwschap, weduweschap, statistieken en numerieke gegevens",

author = "Rolden, \{Herbert J A\} and \{van Bodegom\}, David and Westendorp, \{Rudi G J\}",

year = "2014",

month = dec,

day = "23",

doi = "10.1371/journal.pone.0115478",

language = "English",

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TY - JOUR

T1 - Changes in health care expenditure after the loss of a spouse

T2 - Data on 6,487 older widows and widowers in the Netherlands

AU - Rolden, Herbert J A

AU - van Bodegom, David

AU - Westendorp, Rudi G J

PY - 2014/12/23

Y1 - 2014/12/23

N2 - Background: In ageing populations, informal care holds great potential to limit rising health care expenditure. The majority of informal care is delivered by spouses. The loss of informal care due to the death of the spouse could therefore increase expenditure levels for formal care. Objective: To investigate the impact of the death of the spouse on health care expenditure by older people through time. Additionally, to examine whether the impact differs between socio-demographic groups, and what health services are affectedmost. Design: Longitudinal data on health care expenditure (from July 2007 through 2010) from a regional Dutch health care insurer was matched with data on marital status (2004-2011) from the Central Bureau of Statistics. Linear mixed models with log transformed health care expenditure, generalized linear models and two-part models were used to retrieve standardized levels of monthly health care expenditure of 6,487 older widowed subjects in the 42 months before and after the loss of the spouse. Results: Mean monthly health care expenditure in married subjects was J502 in the 42 months before the death of the spouse, and expenditure levels rose by J239 (48%) in the 42 months after the death of the spouse. The increase in expenditure after the death of the spouse was highest for men (J319; 59%) and the oldest old (J553; 82%). Expenditure levels showed the highest increase for hospital and home care services (together J166). Conclusions: The loss of the spouse is associated with an increase in health care expenditure. The relatively high rise in long-term care expenses suggests that the loss of informal care is an important determinant of this rise.

AB - Background: In ageing populations, informal care holds great potential to limit rising health care expenditure. The majority of informal care is delivered by spouses. The loss of informal care due to the death of the spouse could therefore increase expenditure levels for formal care. Objective: To investigate the impact of the death of the spouse on health care expenditure by older people through time. Additionally, to examine whether the impact differs between socio-demographic groups, and what health services are affectedmost. Design: Longitudinal data on health care expenditure (from July 2007 through 2010) from a regional Dutch health care insurer was matched with data on marital status (2004-2011) from the Central Bureau of Statistics. Linear mixed models with log transformed health care expenditure, generalized linear models and two-part models were used to retrieve standardized levels of monthly health care expenditure of 6,487 older widowed subjects in the 42 months before and after the loss of the spouse. Results: Mean monthly health care expenditure in married subjects was J502 in the 42 months before the death of the spouse, and expenditure levels rose by J239 (48%) in the 42 months after the death of the spouse. The increase in expenditure after the death of the spouse was highest for men (J319; 59%) and the oldest old (J553; 82%). Expenditure levels showed the highest increase for hospital and home care services (together J166). Conclusions: The loss of the spouse is associated with an increase in health care expenditure. The relatively high rise in long-term care expenses suggests that the loss of informal care is an important determinant of this rise.

KW - aged

KW - aged 80 and over

KW - death

KW - demography

KW - female

KW - health expenditure

KW - male

KW - middle aged

KW - epidemiology

KW - Netherlands

KW - socioeconomic factors

KW - spouses

KW - widowhood

KW - statistics & numerical data

KW - spousal support

KW - older adults

KW - ouderen

KW - 80 jaar en ouder

KW - dood

KW - demografie

KW - vrouwelijk

KW - gezondheidsuitgaven

KW - mannelijk

KW - middelbare leeftijd

KW - epidemiologie

KW - Nederland

KW - socio-economische factoren

KW - echtgenoten

KW - weduwschap

KW - weduweschap

KW - statistieken en numerieke gegevens

U2 - 10.1371/journal.pone.0115478

DO - 10.1371/journal.pone.0115478

M3 - Article

C2 - 25536040

SN - 1932-6203

VL - 9

JO - PLOS ONE

JF - PLOS ONE

IS - 12

M1 - e115478

ER -

Changes in health care expenditure after the loss of a spouse: Data on 6,487 older widows and widowers in the Netherlands

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Keywords

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