Out-of-pocket spending among the wealthiest (the top 20%), on average, was 154% greater than among the least wealthy (the bottom 20%), or an estimated $18,233 compared with $7,173, respectively.
The variation between lowest- and highest-income was 58%, they said. For those with the least income, out-of-pocket spending was $9,046 compared with $14,269 among those with income in the top 20%.
It appears the wealthy are better able to afford supportive home-care services or more pricey long-term care, the researchers wrote.
“These differences appear to be driven mostly by greater spending for nursing homes, as well as for helpers, home healthcare, and other sources of spending that likely help maintain the independent of people living at home,” the paper said.
Overall, in the last year of life, out-of-pocket healthcare costs totaled $11,618.
Among the highest spenders (the 99th percentile), the estimated average spending is dizzying: overall out-of-pocket costs, $94,310; hospital and nursing home care, $75,902; insurance, $21,602.
Researchers relied on estimates to adjust for some of the survey's limits. They stressed the risk of error in cases of extraordinarily high spending must be carefully considered to avoid inflated figures or, conversely, dismissing valid numbers. To address this risk, researchers relied on the high end of spending for similar services reported elsewhere and created spending limits for any outliers, though they acknowledge the limit for drug spending was somewhat arbitrary.
They used a larger sample when confronted with limited data for some services. And researchers also adjusted for the fact that the survey captured spending that varied in duration, since the survey capture out-of-pocket costs for those who died at any point between the biennial surveys.