Healthcare services and medication use among widowed partners of patients deceased due to cancer - results from the Survey of Health, Ageing and Retirement in Europe (SHARE)

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

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.