Health Services Research article titled "Medicare expenditures attributable to dementia" by PEDAL lab researchers was cited in the October 21, 2019 The UpShot article by Austin Frakt.

In the United States, people who need long-term care (LTC) face a system with large gaps in coverage, and they rely on friends and family to fill these gaps. Medicaid finances the majority of paid LTC, but people must exhaust their resources to qualify. Medicare and private health insurance do not cover LTC, and the private market for long-term care insurance is small and shrinking. Unpaid family and friends provide most long-term services, but the value of their services is rarely reflected in debates about LTC financing and delivery.

In this article, the authors conducted a systematic review of studies reporting the direct healthcare costs of treating older adults with diagnosed Alzheimer disease and related dementias (ADRD) within private Medicare managed care plans. 

Medicare pays for 100% of postacute care provided by skilled nursing facilities (SNFs) during the first 20 days within a benefit period. However, on the 21st day, most patients become responsible for a daily copayment of more than $150. This copayment may present a significant financial burden for some patients—particularly those with limited economic means—and motivate them to discharge from SNFs on the 20th day of care based on their financial resources rather than their recovery status.

This article details the ways in which financial burden imposed by work-related injury/illness, and points out areas which are under-researched to focus policy efforts where improvement is most needed.

This article estimates dementia's incremental cost to the traditional Medicare program. The authors compared Medicare expenditures for 60 months following a claims-based dementia diagnosis to those for a randomly selected, matched comparison group.   Dementia's five-year incremental cost to the traditional Medicare program is approximately $15 700 per patient, nearly half of which is incurred in the first year after diagnosis. Increased costs for individuals with dementia were driven by more intensive use of Medicare part A covered services.

This article estimates out-of-pocket costs in the last year of life for individuals who required intensive care in the months prior to death and examine how these costs vary by insurance coverage.

This article examines how patient outcomes and Medicare spending are affected by the decision to discharge patients to home with home health care vs to a skilled nursing facility for postacute care. The authors find that among Medicare beneficiaries eligible for postacute care at home or in a skilled nursing facility, discharge to home with home health care was associated with higher rates of readmission, no detectable differences in mortality or functional outcomes, and lower Medicare payments.

Research on home‐based long‐term care has centered almost solely on the costs; there has been very little, if any, attention paid to the relative benefits. This study exploits the randomization built into the Cash and Counseling Demonstration and Evaluation program that directly impacted the likelihood of having family involved in home care delivery.

Norma B. Coe, PhD, published a study in the Journal of Pension Economics & Finance examining who switches to value-based insurance among state employees in WA, where the insurance explicitly decreases premiums without changing out-of-pocket costs. Among other findings, the authors find that the peak age for switching insurance plans is 35–45.