Using U.S. Medicare records to evaluate the indirect health effects on spouses: a case study in Alzheimer’s disease patients

BMC Health Services Research

Lee Bowman²  Daniel E Ball²  Kristin Kahle-Wrobleski²  Joanna M Kubisiak¹  Daniel M Gilden¹ 

[1] JEN Associates, 5 Bigelow Street, Cambridge, MA 02139, USA;Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA

关键词: Psychological stress;    Caregivers;    Indirect costs;    Medical costs;    Spouses;    Administrative records;    Medicare;    Dementia;    Alzheimer’s disease;   

Others  :  1127056
DOI  :  10.1186/1472-6963-14-291

 received in 2013-09-22, accepted in 2014-06-27,  发布年份 2014

【 摘 要 】

Background

The burden experienced by spouses of patients with Alzheimer’s disease (AD) may have negative consequences for their physical health. We describe here a method for analyzing United States Medicare records to determine the changes in health service use and costs experienced by spouses after their marital partner receives an AD diagnosis.

Methods

We initially identified all beneficiaries in the 2001–2005 Medicare 5% sample who had multiple claims listing the ICD-9 diagnostic code for AD, 331.0. The 5% sample includes spouses who share a Medicare account with their marital partners because they lack a sufficient work history for full eligibility on their own. A matched cohort study assessed incremental health costs in the spouses of AD patients versus a control group of spouses of non-AD patients. Longitudinal and cross-sectional analyses tracked the impact of a patient’s AD diagnosis on his or her spouse’s healthcare costs.

Results

Our method located 54,593 AD patients of whom 11.5% had spouses identifiable via a shared Medicare account. AD diagnosis in one member of a couple was associated with significantly higher monthly Medicare payments for the other member’s healthcare. The spouses’ elevated costs commenced 2 to 3 months before their partners’ AD diagnosis and persisted over the follow-up period. After 31 months, the cumulative additional Medicare reimbursements totaled a mean $4,600 in the spouses of AD patients. This excess was significant even after accounting for differences in baseline health status between the cohorts.

Conclusion

The study methodology provides a framework for comprehensively evaluating medical costs of both chronically ill patients and their spouses. This method also provides monthly data, which makes possible a longitudinal evaluation of the cost effects of specific health events. The observed correlations provide a coherent demonstration of the interdependence between AD patients’ and spouses’ health. Future research should examine caregiving burden and other possible factors contributing to the AD spouses’ health outcomes. It should also extend the method presented here to evaluations of other chronic diseases of the elderly.

【 授权许可】

   
2014 Gilden et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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