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Single Payer Must Include Rational & Compassionate Long Term Care

Health Care Use and Out-of-pocket Spending by Persons With Dementia Differ Between Europe and the United States, Medicare Care, June 2021, By Sabrina Lenzen, Pieter Bakx, Judith Bom, Eddy van Doorslaer

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…

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 (95% confidence interval, 3914-4899) vs. $246 (73-418).

Conclusions: 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.

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Comment by Steffie Woolhandler and David Himmelstein

When individuals require extensive assistance with daily living, most patients and families prefer home care to care in a nursing home. The COVID-19 pandemic has highlighted the sorry state of long term care – particularly nursing home care – in the US. This study documents the far greater reliance in the US as compared to Europe on nursing homes (67% more nursing home days per year on average) for the care of dementia patients, a corollary of the US deficit for home care (49% fewer hours). And the out-of-pocket costs to patients are also strikingly different: more than $4000 higher per patient in the US in 2017.

Single payer reform must include a rational and compassionate long term care program. Although not detailed in this article, the programs in several European nations include key elements that should be adopted in the US – e.g. salaries for family members who forego other paid employment to care for a disabled loved one, and the provisions of full time (or respite) live-in caretakers.