The Effect of Functional Limitations and Hospitalization on Out-of-Pocket Medical Payments in older Adults - Abstract
Objective: To evaluate the effect of functional limitations and hospitalization on out-of-pocket medical payments (OOPs) of community-dwelling adults 50 years or older using a nationally representative data set.
Methods: We utilized the 2010 data from the Health and Retirement Study (HRS). Americans 50 years or older were surveyed about their Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs), and hospital admissions over the past 2 years. OOPs were assessed by self-report over the last 2-year period. Bivariate analyses of the association between OOPs and socio-demographic factors, ADLs/IADLs and hospitalizations were first performed. Then, a general linear regression analysis was conducted to assess the relationship between OOPs, functional limitations and number of hospitalizations after controlling for socio-demographic variables. We further conducted a generalized linear model to ascertain the statistical significance of these variables.
Results: 5,614 (27.3%) out of 20,585older adults had one or more functional limitations in either ADLs or IADLs. Among the 20,585respondents, 27% had one or more inpatient admissions. The mean OOPs were $2,497, with the 25th and 75th percentile at $150 and $2,730, respectively. After controlling for insurance type and socio-demographic factors, our general linear regression analysis demonstrated that those with 3 or more ADL limitations had $1,165 more in OOPs compared to those without any limitations, while respondents with 3 or more inpatient admissions had $3,193 more in OOPs compared to those who were never hospitalized. These findings remained statistically significant in the generalized linear model analysis.
Conclusion/implication: Limitations of ADLs and hospitalizations both independently predicted large increases in OOPs among community-dwelling older adults even after adjusting for insurance coverage. This highlights the need to understand and address OOPs of care among the older population with functional limitations and hospitalizations.