Chart 4-10 WHERE THE MEDICAID DOLLAR FOR THE Source: Chollet, Deborah. "Financing the Elderly's Health PRIVATE SPENDING Private spending for health care not covered by government sources includes: medigap insurance that the elderly purchase or that employers provide as a retirement benefit; insurance provided by employers for elderly workers; and out-of-pocket spending by or in behalf of the elderly. Average private spending for the elderly amounted to $2,169 per capita in 1987. Even with the substantial contribution of public funds, the elderly bear considerable financial burden for health care out of their own pockets. Between 1977 and 1987, the elderly's out-of-pocket spending for health care tripled, reaching 29 percent of their total health care costs in 1987. Direct out-of-pocket health care expenses for the elderly averaged $1,533 per person in 1987. This amount excludes premium payments for Medicare Part B. Other per capita private costs included $430 by insurance companies, $181 per Medicare enrollee for Part B premiums, and $25 by other private sources in 1987. The elderly's private spending for health care goes to a variety of providers with nursing homes accounting for almost a third of private expenditures. Chart 4-11 WHERE THE PRIVATE HEALTH CARE DOLLAR Source: Chollet, Deborah. "Financing the Elderly's Health OTHER FUNDING SOURCES The costs of health care for the elderly not met by Medicare, Medicaid, and out-of-pocket expenditures are funded by private insurance, foundations, and other government sources such as the Veterans Administration, Department of Defense, Indian Health Service, States, and counties. Chapter 5 SOCIAL CHARACTERISTICS Marital status and living arrangements of older persons (65 years and over) 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 significantlywith large differences by marital status and living arrangements. A surprising proportion of older persons bear the burden of high housing 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, voter participation, and the use of community services. MARITAL STATUS AND LIVING ARRANGEMENTS MOST OLDER MEN ARE MARRIED, BUT MOST OLDER WOMEN ARE WIDOWED While most older men remain married until they die, most older women are widowed (chart 5-1). This trend holds true for men and women of all races with blacks having higher rates of widowhood than whites or hispanics. There are several reasons for this discrepancy. Men have a shorter average life expectancy and thus tend to predecease their wives. In addition, men tend to marry women who are younger than themselves. Finally, men who lose a spouse through divorce or death are more likely to remarry than are women in the same situation.1 Elderly widowed men have remarriage rates over eight times higher than those of women.2 In 1988, 7 percent of all older men were married and living with their spouses (table 5-1). Only 40 percent of older women were living with their spouses and 49 percent were widowed. This difference was more pronounced among people 75 years or older. Twothirds (67 percent) of men in this age group were living with a spouse compared to less than one-fourth (24 percent) of women. Only 1 of every 20 older men and women in 1988 had never been married. Very small percentages of older persons of all races are divorced. 1U.S. Bureau of the Census. "Demographic and Socioeconomic Aspects of Aging in the United States." Current Population Reports Series P-23, No. 138 (August 1984). 2 National Center for Health Statistics. "Advance Report on Final Marriage Statistics, 1984." Monthly Vital Statistics Report, Vol. 36, No. 2, Supplement (2) (June 1987). TABLE 5-1. MARITAL STATUS OF OLDER PEOPLE, BY AGE, SEX, RACE, AND HISPANIC ORIGIN: Note. Percentage distributions may not add to 100.0 due to rounding. Source: U.S. Bureau of the Census. Unpublished data from the March 1988 Current Population Survey. Chart 5-1 PERCENT OF OLDER MEN AND WOMEN WIDOWED BY AGE, RACE AND HISPANIC ORIGIN: 1988 Source: U.S. Census Bureau. Unpublished data from the March MOST ELDERLY MEN LIVE IN FAMILY SETTINGS, MOST ELDERLY WOMEN LIVE ALONE Two-thirds (67 percent) of older, noninstitutionalized people lived in a family setting in 1988. As with marital status, however, these statistics vary considerably by sex, and the differences grow larger with advancing age (table 5-2). For example, nearly four of every five men 75 years old or older (76 percent) lived with their spouses or other family members, compared to less than half (46 percent) of women in this age group. |