OUT-OF-POCKET COSTS Even with the substantial contribution of public funds, the elderly bear a considerable financial burden for health care out of their own pockets. Direct out-of-pocket health costs for the elderly averaged 15 percent of their income in 1984-the same as before Medicare and Medicaid were enacted. Direct out-of-pocket health care expenses for the elderly averaged $1,059 per person in 1984. The majority of these expenses are for nursing home care, physician visits and services, and health aids not covered by Medicare, Medicaid, or private insurance. (NOTE: Unless otherwise noted, data for health care expenditures for the elderly in this section are from: Waldo, Daniel and Lazenby, Helen; Demographic characteristics and health care use and expenditures by the aged in the United States: 19771984, Health Care Financing Review; Fall, 1984; Volume 6, Number 1.) CHART 5-11 WHERE THE OUT OF POCKET DOLLAR FOR THE ELDERLY GOES: 1984 SOURCE: Health Care Financing Administration, Office of Financial and Actuarial Analysis MEDICARE In 1984, Medicare was responsible for 49 percent of all personal health care expenditures. Costs for hospitals, which account for over 69 percent of all the dollars Medicare spends for health care, are fueling Medicare's growth (chart 5-12). The Congressional Budget Office has estimated that only 2 percent of the projected annual average 13.2 percent growth in hospital reimbursements from 1984 to 1985 will be due to the aging of the population. CHART 5-12 WHERE THE MEDICARE DOLLAR FOR THE ELDERLY GOES: 1984 SOURCE: Health Care Financing Administration, Office of Financial and Actuarial Analysis MEDICAID Medicaid pays about 13 percent of personal health care expenditures for the elderly, the great majority of which is for that small portion of the population using long-term care (chart 5-13). The gap between funding by Medicare, Medicaid, and out-of-pocket costs for health care for the elderly is covered by private insurance, foundations, and other Government sources such as the Veterans Administration, Department of Defense, Indian Health Service, States, and countries. CHART 5-13 WHERE THE MEDICAID DOLLAR FOR THE ELDERLY GOES: 1984 SOURCE: Health Care Financing Administration, Office of Financial and Actuarial Analysis Chapter 6 SOCIAL CHARACTERISTICS The marital status and living arrangements of older persons vary tremendously by sex. Most men, for instance, spend their elderly years married and in family settings, whereas most older women spend their later years as widows outside of family settings. The housing situation of older persons also varies significantly— with large differences by marital status and living arrangements. A surprising proportion of older persons bear the burden of high household expenses in relation to income. Inadequate housing and the lack of telephones are also problems for a small but significant number of older persons. The following section describes these and other social characteristics of the older population, such as educational level and voter participation. A. MARITAL STATUS AND LIVING ARRANGEMENTS UNLIKE ELDERLY MEN, MOST ELDERLY WOMEN ARE WIDOWED AND LIVE ALONE Over two-thirds (67 percent) of older, noninstitutionalized persons lived in a family setting in 1983. However, patterns of living arrangements and marital status differ sharply between elderly men and women, and the disparity increases for the oldest groups. For instance, in 1983 nearly three-quarters of the men and less than half of the women age 75 and older lived in a family setting (table 6-1). Elderly women are more likely to be widowed than married (chart 6-1), and a substantial proportion live alone (chart 6-2). The male/female disparity is more marked at older ages; in 1984, 67 percent of women 75 and older were widowed while 67 percent of the men in this age group were still married. And, in 1983, 65 percent of men 75 and older lived with their wives while only 21 percent of 75-plus women lived with husbands. These differences are caused by the combined effects of the higher age-specific death rates for adult men and the tendency for men to marry younger women. 1 1 Siegel, Jacob. Demographic Aspects of Aging and the Older Population in the United States. Series p-23, No. 59, 1982. PERCENT WIDOWED CHART 6-1 WIDOWHOOD OF PERSONS 55 AND OVER BY RACE AND SEX Source: Bureau of the Census. CPS, Series P-20, No. 389 TABLE 6-1.-LIVING ARRANGEMENTS OF OLDER MALES AND FEMALES, 1983 Percent in category: Not in household. Living alone. Living in household with someone else. Living in household with spouse present.. 75+ 65-74 55-64 Source: U.S. Bureau of the Census, Current Population Survey, March 1983, compiled by the Congressional Research Service. TABLE 6-2.-MARITAL STATUS OF OLDER MALES AND FEMALES, 1984 Elderly widowed men have remarriage rates about seven times higher than those of women. The "average" widow who has not re |