title: Changes in health care expenditure after the loss of a spouse: data on 6,487 older widows and widowers in the Netherlands.
abstract: BACKGROUND
  In ageing populations, informal care holds great potential to limit rising health care expenditure. The majority of informal care is delivered by spouses. The loss of informal care due to the death of the spouse could therefore increase expenditure levels for formal care.
  
  
  OBJECTIVE
  To investigate the impact of the death of the spouse on health care expenditure by older people through time. Additionally, to examine whether the impact differs between socio-demographic groups, and what health services are affected most.
  
  
  METHODS
  Longitudinal data on health care expenditure (from July 2007 through 2010) from a regional Dutch health care insurer was matched with data on marital status (2004-2011) from the Central Bureau of Statistics. Linear mixed models with log transformed health care expenditure, generalized linear models and two-part models were used to retrieve standardized levels of monthly health care expenditure of 6,487 older widowed subjects in the 42 months before and after the loss of the spouse.
  
  
  RESULTS
  Mean monthly health care expenditure in married subjects was € 502 in the 42 months before the death of the spouse, and expenditure levels rose by € 239 (48%) in the 42 months after the death of the spouse. The increase in expenditure after the death of the spouse was highest for men (€ 319; 59%) and the oldest old (€ 553; 82%). Expenditure levels showed the highest increase for hospital and home care services (together € 166).
  
  
  CONCLUSIONS
  The loss of the spouse is associated with an increase in health care expenditure. The relatively high rise in long-term care expenses suggests that the loss of informal care is an important determinant of this rise.
authors.affiliation: Leyden Academy on Vitality and Ageing, Leiden, The Netherlands; Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Herbert J A
authors.initials: HJ
authors.lastname: Rolden
authors.affiliation: Leyden Academy on Vitality and Ageing, Leiden, The Netherlands; Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: David
authors.initials: D
authors.lastname: van Bodegom
authors.affiliation: Leyden Academy on Vitality and Ageing, Leiden, The Netherlands; Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Rudi G J
authors.initials: RG
authors.lastname: Westendorp
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003643:Death; D003710:Demography; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012959:Socioeconomic Factors; D018454:Spouses / Q000706:statistics & numerical data*; D017805:Widowhood