An examination of Medicare claims, spanning 16 years, has uncovered a striking discrepancy in dementia care expenditures related to race and ethnicity. Black and Hispanic Medicare beneficiaries incurred higher costs than Whites, according to findings funded by the National Institute on Aging (NIA) and reported in the Journal of the American Geriatrics Society.
The inquiry, spearheaded by Tufts Medical Center’s research team, pored over comprehensive data from the NIA Health and Retirement Study coupled with Medicare claims. It focused on individuals 65 or older who had been diagnosed with dementia between the years 2000 and 2016. Among this cohort, the team zeroed in on 5,532 patients who were registered with Medicare for at least one year before their initial dementia diagnosis and up to six months preceding their passing. This demographic was predominantly female, making up 61%, with an average age of 81 at the time of their initial diagnosis.
By assessing the expenses related to dementia care for different racial and ethnic groups during four critical periods – the year prior to diagnosis, the first year following it, during ongoing care, and in the last year of life – the researchers demarcated clear financial disparities. On average, total Medicare costs throughout all four periods stood at $165,730 for Black individuals; Hispanic beneficiaries faced $160,442, while White patients incurred $136,326.
These financial inequities were consistent throughout the dementia care journey. Before a diagnosis, Black beneficiaries averaged $26,337 in Medicare bills, with Hispanics at $23,176 and Whites at $21,399. Costs for the year immediately succeeding diagnosis remained elevated for Black beneficiaries at $20,429; Hispanics at $17,182, and Whites at $18,244. When examining the ongoing care phase, average costs were $67,671 for Blacks, increased to $72,615 for Hispanics, and decreased to $57,184 for Whites. Cumulatively, Black Medicare recipients with dementia faced the highest expenditures across all care phases.
The researchers found that the final year of life was the most costly for all three groups, with Black ($51,294) and Hispanic ($47,469) Medicare beneficiaries spending significantly more than Whites ($39,499). This disparity was primarily attributed to greater utilization of expensive medical services such as emergency room visits, inpatient hospital stays, and intensive care during the last year of life.
The study also revealed that cultural, patient, or caregiver preferences might influence the differences in healthcare usage. It raised concerns about potential racial and ethnic inequities in the coordination of dementia care, the regularity of follow-up appointments, and communication regarding end-of-life care options.
The research team acknowledged limitations in their study, such as potential biases in race and ethnicity analysis due to the reliance on Medicare claims-based algorithms. They also noted the exclusion of costs associated with informal family and community care, which are more commonly utilized by Black and Hispanic families. Future research efforts will aim to include a broader range of racial/ethnic groups, such as Asian Americans, Pacific Islanders, and American Indians.