Exhibit 1
Research Questions
„
The Impact of Health Expenses on
Older Women’
Women’s Financial Security
„
Juliette Cubanski, Ph.D.
The Henry J. Kaiser Family Foundation
„
AcademyHealth
2007 Annual Research Meeting
Orlando, Florida
„
3 June 2007
„
What is the burden of outout-ofof-pocket health care
spending as a share of income among older women,
and how does it compare among various subgroups?
Exhibit 3
Data and Methods
WorkingWorking-age women have lower incomes than men
„
Wage disparity and lower workforce participation
Analyzed 2002 Medicare Current Beneficiary Survey Cost and Use file
file
„
Women accumulate fewer assets for retirement
than men
Lower workforce participation affects social security
payments, retiree benefits and income (pensions, IRAs)
„
„
Women have longer lifespans than men
„
„
How much do older women and men spend on
health care and what is the distribution of spending
for various services?
Exhibit 2
„
„
What sources of insurance coverage do older women
rely on, and how does this compare to older men?
Women’
Women’s Economic & Demographic Reality
„
„
What are the key differences in health status and
utilization of medical and longlong-term care services
between women and men age 65+?
At age 65, women are expected to live another 20 years,
compared to 17 for men
Women have more longlong-term care needs than men
„
Sample population included 6,195 women and 4,396 men age 65 years
years
or older living either in the community or in a facility
Compared women and men age 65+ on Medicare to assess key
differences in age, income, marital status, insurance coverage, health
status, and utilization of medical and longlong-term care (LTC) services
Examined outout-ofof-pocket spending on health care by aggregating
spending on Medicare Parts A and B, supplemental insurance
premiums, and all reported medical and LTC services
Estimated the burden of outout-ofof-pocket health care spending among
women and men age 65+ by calculating the ratio of annual outout-ofofpocket spending on medical care to annual income
Exhibit 4
Exhibit 5
Key Demographic, Economic, and Health Status Indicators
of Medicare Beneficiaries Age 65+, 2002
Women 65+
Average age
Percent age 85+
Lives alone
Among 85+, lives alone
Lives in longlong-term care facility
Among 85+, lives in longlong-term care facility
Men 65+
(20.8 million)
(15.1 million)
76.1 years
74.7 years
16%
10%
41%
19%
59%
32%
6%
3%
21%
11%
$25,921
$36,161
56%
37%
Fair/poor health status
26%
23%
Two or more chronic conditions
65%
53%
Cognitive/mental impairment
21%
17%
Average annual income
Percent with income less than $20,000
Two or more limitations in activities of daily living
Number of home health visits*
Number of prescription drug fills*
Health Insurance Coverage Among Medicare
Beneficiaries Age 65+, by Sex, 2002
16%
12%
122 visits
91 visits
31
25
NOTE: Health status indicators exclude the institutionalized population.
population. * Utilization among beneficiaries with reported use of service.
SOURCE: Kaiser Family Foundation analysis of the Medicare Current
Current Beneficiary Survey 2002 Cost and Use File.
32%
37%
Employer-sponsored
Self-purchased
Medicare HMO
30%
28%
16%
None
15%
Other
9%
15%
6%
Medicaid/QMB
1%
Women 65+
9%
2%
Men 65+
SOURCE: Kaiser Family Foundation analysis of the Medicare Current
Current Beneficiary Survey 2002 Cost and Use File.
1
Exhibit 6
Exhibit 7
Distribution of Mean OutOut-ofof-Pocket Health Spending
by Medicare Beneficiaries Age 65+, 2002
Mean and Median OutOut-ofof-Pocket Spending by
Women on Medicare Age 65+, by Age, 2002
$3,991
36%
Premiums
$3,269
$1,450
43%
30%
$1,210
$634
21%
$671
14%
4%
$546
$152
13%
6%
$428
$206
MEAN
$3,991
MEDIAN
$2,595
Prescription drugs
$557
16%
Women 65+
Total OOP = $83 billion
Long-term care:
nursing home; SNF;
home health
Medical/dental visits;
supplies
$1,407
17%
$6,699
Inpatient/outpatient
hospital visits
$2,970
Men 65+
Total OOP = $49 billion
Total
NOTE: Estimates reflect mean outout-ofof-pocket spending for Medicare and private insurance premiums and health care services.
SOURCE: Kaiser Family Foundation analysis of the Medicare Current
Current Beneficiary Survey 2002 Cost and Use File.
$4,114
$3,133
$2,803
$2,312
65-74
75-84
85+
NOTE: Estimates include outout-ofof-pocket spending for Medicare and private insurance premiums and health care services.
SOURCE: Kaiser Family Foundation analysis of the Medicare Current
Current Beneficiary Survey 2002 Cost and Use file.
Exhibit 8
Exhibit 9
OutOut-ofof-Pocket Spending by Women on Medicare
Age 65+, by Age, 2002
OutOut-ofof-Pocket Spending by Women on Medicare
Age 65+, by Insurance Coverage, 2002
Median OutOut-ofof-Pocket Spending
Median OutOut-ofof-Pocket Spending
As Percent of Income
$3,133
$2,803
$2,595
Men
65+:
14%
(Total incl. Premiums/Health Care Services Only)
23%
$3,501
25%
24%
19%
17%
$2,312
Median OutOut-ofof-Pocket Spending
As Percent of Income
Median OutOut-ofof-Pocket Spending
$2,502
$2,499
14%
18%
$1,968
14%
14%
5%
5%
Medicare
HMO
Employersponsored
11%
$846
None
Total
65-74
75-84
Total
85+
65-74
75-84
Medicaid/
QMB
85+
NOTE: Estimates include outout-ofof-pocket spending for Medicare and private insurance premiums and health care services.
SOURCE: Kaiser Family Foundation analysis of the Medicare Current
Current Beneficiary Survey 2002 Cost and Use file.
8%
8%
Medicare
HMO
EmployerSelfsponsored purchased
None
Medicaid/
QMB
Selfpurchased
NOTE: Estimates include outout-ofof-pocket spending for Medicare and private insurance premiums and health care services.
SOURCE: Kaiser Family Foundation analysis of the Medicare Current
Current Beneficiary Survey 2002 Cost and Use file.
Exhibit 10
Exhibit 11
OutOut-ofof-Pocket Spending by Women on Medicare
Age 65+, by Race/Ethnicity, 2002
OutOut-ofof-Pocket Spending by Women on Medicare
Age 65+, by Income, 2002
Median OutOut-ofof-Pocket Spending
Median OutOut-ofof-Pocket Spending
As Percent of Income
Median OutOut-ofof-Pocket Spending
$2,825
$2,821
$3,002
26%
Median OutOut-ofof-Pocket Spending
As Percent of Income
$2,927
22%
$2,615
18%
$1,533
13%
$1,437
16%
15%
$1,614
13%
8%
White
African
American
Hispanic
White
African
American
NOTE: Estimates include outout-ofof-pocket spending for Medicare and private insurance premiums and health care services.
SOURCE: Kaiser Family Foundation analysis of the Medicare Current
Current Beneficiary Survey 2002 Cost and Use file.
Hispanic
$10,000 $10,001- $20,001- $30,001- $40,000
or less $20,000 $30,000 $40,000 or more
$10,000
or less
$10,001- $20,001- $30,001$20,000 $30,000 $40,000
$40,000
or more
NOTE: Estimates include outout-ofof-pocket spending for Medicare and private insurance premiums and health care services.
SOURCE: Kaiser Family Foundation analysis of the Medicare Current
Current Beneficiary Survey 2002 Cost and Use file.
2
Exhibit 12
Key Findings and Implications
„
„
„
„
Older women have greater health care needs and
lower incomes than older men
LongLong-term care use and spending are key differences
between elderly women and men
Older women spend more outout-ofof-pocket on health care
than older men, both in dollars and as a share of their
incomes
Pressure to control costs in the private and public
health insurance sectors could disproportionately
impact older women
3