FAMILY INCOME (In thousands of dollars) SOURCE: Congressional Budget Office tabulations of Survey of Income and Program Participation (SIPP). NOTE: People covered under both a group and an individual plan are likely to have been classified above as covered by group 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: 197784, Health Care Financing review; Fall, 1984; Volume 6, No. 1.) MEDICARE In 1985, Medicare covered 45 percent of all personal health care expenditures for the elderly.33 Medicare's role primarily involves financing acute care services. Costs for hospitals, which account for over 69 percent of all the dollars Medicare spends for health care, are fueling Medicare's growth (chart 4-13). Seventy-three percent of the cost of hospital services and 44 percent of the cost of physicians' services were paid by the program in 1984. Medicare spending for home health care has grown dramatically since 1968; from 33 Congressional Budget Office, testimony before the Committee on Energy and Commerce, U.S. House of Representatives, March 1986. $60 million in fiscal year 1968 to $2.3 billion in 1985 (3.3 percent of benefit payments). 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 4-14). Medicaid is the principal source of public financing for nursing home care, paying for 41 percent of the total costs. 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 counties. CHART 4-14 WHERE THE MEDICAID DOLLAR FOR THE ELDERLY GOES: 1984 SOURCE: Health Care Financing Administration, Office of Chapter 5 SOCIAL CHARACTERISTICS 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 significantlywith 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 1985. 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 1985, over three-quarters of the men but less than half of the women age 75 and older lived in a family setting (table 5−1). TABLE 5-1.-LIVING ARRANGEMENTS OF OLDER MALES AND FEMALES, 1985 Source: U.S. Bureau of the Census, "Marital Status and Living Arrangements: 1985," Current Population Reports, P-20, No. 410, table 6, November 1986. Elderly women are more likely to be widowed than married (chart 5-1), and a substantial proportion live alone (table 5-1). The male/female disparity is more marked at older ages; in 1985, 68 percent of women 75 and older were widowed compared to 23 percent of men in this age group. And 67 percent of men 75 and older lived with their wives while only 23 percent of 75-plus women lived with husbands (table 5-1). 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 SOURCE: U.S. Bureau of the Census, Current Population Survey. Series P-20, No. 389 Elderly widowed men have remarriage rates about seven times higher than those of women. The "average" widow who has not remarried is 65 years old, has been widowed for 6 years, and can expect to live an additional 19 years as a widow.2 TABLE 5-2.-MARITAL STATUS OF OLDER MALES AND FEMALES, 1985 Source: U.S. Bureau of the Census, "Households, Families, Marital Status, and Living Arrangements: March 1985" Current Population Reports, P20, No. 402. Elderly white males have the highest probability of being married, elderly black females the least. Black females are most likely 1 Siegel, Jacob, Demographic Aspects of Aging and the Older Population in the United States. Series P-23, No. 59, 1982. 2 U.S. Senate Special Committee on Aging, 1984. |