The Burden of OutOut-of
of--Pocket
Health Care Expenditures for
Older Women
Amy K
K. Taylor
Taylor, Ph
Ph.D.
D
Lan Liang, Ph.D.
June 27, 2010
Background
 Women use more medical care than men when they
y




are young (18 – 64)
Mean medical expenditures for men catch up to
women’s byy age
g 45
There are significant differences in socio
socio--demographic
and health characteristics between older women and
men
Among those age 65 and older, women are more
likely to have hypertension, asthma, and arthritis than
men – rates of diabetes and cancer are higher for
men
Women of all ages are more likely to spend more than
10 percent of their income outout-of
of--pocket than men;
this difference is particularly pronounced in the older
than 65 age group
Source: Household Component of the Medical Expenditure Panel Survey, 2006
Out-of
Outof--pocket Expenditure
greater than 10% of Income
18
16
14
Percent
12
10
women
men
8
6
4
2
0
18-29
30-44
45-64
65+
Age
Source: Household Component of the Medical Expenditure Panel Survey, 2006
Out-of
Outof--pocket Expenditure greater
than 10% of Income – Age 65+
40 00
40.00
35.00
30.00
Perce
ent
25.00
Women
20.00
Men
15.00
10.00
5.00
0.00
Poor/Near poor
Low Income
Middle Income
High Income
Income
Source: Household Component of the Medical Expenditure Panel Survey, 2006
Out--of
Out
of--pocket Expenditure greater
than 10% of Income
16
14
Perc
cent
12
10
women
8
men
6
4
2
0
18-29
30-44
45-64
65+
Age
Source: Household Component of the Medical Expenditure Panel Survey, 2007
Out-of
Outof--pocket Expenditure greater
than 10% of Income – Age 65+
30
25
Percent
20
women
15
men
10
5
0
poor/nr poor low income
middle
income
high income
Source: Household Component of the Medical Expenditure Panel Survey, 2007
Data and Methods
 2007 Medical Expenditure Panel Survey





(MEPS)
N ti
Nationally
ll representative,
t ti
non
non--institutionalized
i tit ti
li d
civilians
Age 65 and over
N=3,478 (1,976 women, 1,502 men)
Bivariate analysis
Multivariate analysis
Sample Characteristics: How do
older men and women differ?
 Very similar in many regards
 Some important differences:
– Women are more likely to have 3 or more
chronic conditions
– Men are more likely to have any private
insurance coverage
– Women are more likely to be poor or near
poor
– Men
M are more likely
lik l tto b
be married
i d
Source: Household Component of the Medical Expenditure Panel Survey, 2007
Income
High Burden – Age 65+
Women
Men
6.86
8.65
18.98
38.12
20.57
43.06
27.72
36.05
Poor or near poor
Middle Income
Low Income
High Income
Poor or near poor
Middle Income
Low Income
High Income
Source: Household Component of the Medical Expenditure Panel Survey, 2007
Marital Status
High Burden–
Burden– Age 65+
Women
Men
3.03
11.86
25.52
16.39
53.51
59.26
12.19
18 24
18.24
Married
Widowed
Divorced/Separated
Never Married
Married
Widowed
Divorced/Sparated
Never Married
Source: Household Component of the Medical Expenditure Panel Survey, 2007
Age - High Burden
Women and Men
Women
Men
16.84
27.29
35.03
42.11
41.06
37.67
65 - 74
75 - 84
85+
65 - 74
75 - 84
Source: Household Component of the Medical Expenditure Panel Survey, 2007
85+
Chronic Conditions
High Burden – Age 65+
Women
Men
5 03
5.03
8.46
10.52
19.27
23.71
52.03
60.75
20.24
0 Conditions
Two of these
One condition only
Three or more
0 Condition
Two of these
One condition only
Three or more
Source: Household Component of the Medical Expenditure Panel Survey, 2007
Chronic Conditions
High Burden - Age 65+
80
70
60
50
40
Men
Women
30
20
10
Ba
ck
Pa
in
itis
er
an
c
C
Ar
th
r
D
ia
b
et
es
PD
CO
As
th
m
a/
tD
is
ea
r
H
H
yp
er
te
n
sio
ea
se
n
0
Source: Household Component of the Medical Expenditure Panel Survey, 2007
Multivariate Approach
 Calculate
C l l t th
the relative
l ti b
burden
d off h
health
lth care ffor men




and women; Define high burden as spending more
than 10% of family income outout- of
of--pocket for health
care
Estimate separate linear probability models for men
and women.
Explanatory variables include education, marital
status, race/ethnicity, poverty status, health insurance,
health status, health behavior/attitudes, and region
and urbanicity
Use OaxacaOaxaca-Blinder decomposition techniques to
analyze the relative contributions of each factor to the
gender
d diff
differences iin th
the b
burden
d off outoutt-ofoff-pocket
k t
health care expenditures
Analyses
y
account for complex surveyy design
g
Oaxaca-Blinder
OaxacaDecomposition
Source: Household Component of the Medical Expenditure Panel Survey, 2007
Detailed Decomposition Results:
% explained by each factor
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
-5%
-10%
race
educ
married* income insurance* health* behavior region
groups**
*Statistically significant at the 5% level
Source: Household Component of the Medical Expenditure Panel Survey, 2007
Summary
 Burden of outout-of
of--pocket spending for medical care




falls more heavily on women than men, particularly for
the oldest age
g g
group
p
Observed characteristics explain more than 50% of
the gap between men and women
Al
Almost
th
half
lf off th
the explained
l i d diff
difference was d
due tto th
the
fact that women are more likely to be poor, near poor,
or low income
Marital status (not being married) and poor health are
also important contributors
A
Access
tto Medicaid
M di id narrows th
the gap b
by about
b t6
percentage points
Source: Household Component of the Medical Expenditure Panel Survey, 2007