Health Care Use and Out-of-pocket Spending by Persons With Dementia Differ Between Europe and the United States

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)
87 Downloads (Pure)


Background: Persons with dementia need much care, but what care is used and how the burden of financing is divided between persons with dementia, caregivers, and public programs may differ between countries. Objective: The objective of this study was to compare how health care use and out-of-pocket (OOP) spending associated with dementia differ between the United States and Europe, with and without controlling for background characteristics. Research Design: We use prospectively collected survey data from the United States-based Health and Retirement Study (n = 48,877) and the Survey of Health, Ageing, and Retirement in Europe (n = 98,971) including all adults over the age of 70 years. Dementia status is imputed using a validated algorithm. After first reporting the observed differences in care use, we analyze how care use is associated with dementia using multivariate regressions, controlling for other health conditions and background characteristics. Results: Persons with dementia in the United States use 50% less formal home care per year than persons living with dementia in Europe [mean (SD) = 236.8 h (1047.4) vs. 463.3 h (1371.2)], but use more nursing home care [75.1 d (131.4) vs. 45.5 d (119.4)). Dementia is associated with higher OOP spending in the United States than Europe [4406 USD (95% confidence interval, 3914-4899) vs. 246 USD (73-418)-2017 price levels]. Conclusions: Health care use and OOP spending differ between Europe and the United States. The far greater reliance on nursing home care in the United States likely causes much higher expenditures for people with dementia and insurance programs alike.

Original languageEnglish
JournalMedical Care
Publication statusPublished - Jun 2021

Bibliographical note

Funding Information:
The authors thank Jonathan Skinner for his insightful comments and suggestions. This paper uses data from SHARE Waves 1, 2, 3, 4, 5, 6, and 7 (doi’s: 10.6103/SHARE.w1.700, 10. 6103/SHARE.w2.700, 10.6103/SHARE.w3.700, 10.6103/SHARE. w4.700, 10.6103/SHARE.w5.700, 10.6103/SHARE.w6.700, 10.61 03/SHARE.w7.700), see Börsch-Supan and colleagues for methodological details. (1) The SHARE data collection has been funded by the European Commission through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812), FP7 (SHARE-PREP: GA N°211909, SHARE-LEAP: GA N° 227822, SHARE M4: GA N°261982) and Horizon 2020 (SHARE-DEV3: GA N°676536, SERISS: GA N°654221), and by DG Employment, Social Affairs, & Inclusion. Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the United States National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C), and from various national funding sources is gratefully acknowledged (

Publisher Copyright:
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.


Dive into the research topics of 'Health Care Use and Out-of-pocket Spending by Persons With Dementia Differ Between Europe and the United States'. Together they form a unique fingerprint.

Cite this