Health Care Use and Out-of-pocket Spending by Persons With Dementia Differ Between Europe and the United States

Background: Persons with dementia need much care, but what care is used and how the burden of financing is divided between persons with dementia, caregivers, and public programs may differ between countries.

Objective: The objective of this study was to compare how health care use and out-of-pocket (OOP) spending associated with dementia differ between the United States and Europe, with and without controlling for background characteristics.

Research design: We use prospectively collected survey data from the United States-based Health and Retirement Study (n=48,877) and the Survey of Health, Ageing, and Retirement in Europe (n=98,971) including all adults over the age of 70 years. Dementia status is imputed using a validated algorithm. After first reporting the observed differences in care use, we analyze how care use is associated with dementia using multivariate regressions, controlling for other health conditions and background characteristics.

Results: Persons with dementia in the United States use 50% less formal home care per year than persons living with dementia in Europe [mean (SD)=236.8 h (1047.4) vs. 463.3 h (1371.2)], but use more nursing home care [75.1 d (131.4) vs. 45.5 d (119.4)). Dementia is associated with higher OOP spending in the United States than Europe [4406 USD (95% confidence interval, 3914-4899) vs. 246 USD (73-418)-2017 price levels].

Conclusions: Health care use and OOP spending differ between Europe and the United States. The far greater reliance on nursing home care in the United States likely causes much higher expenditures for people with dementia and insurance programs alike.