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Letter to the Editor and Authors' Response

Case Western Reserve University

To the Editor:

The article by Yang, Norton, and Stearns entitled "Longevity and Health Care Expenditures: The Real Reasons Older People Spend More," which appeared in the January 2003 issue of this journal, reexamines an important public policy issue in the field of aging. The aging of the baby boomer generation is expected to be the source of anticipated increased expenditures in health care. This expected population trend has important public policy implications on the allocation of public health dollars. In their article, the authors draw the conclusion that the expected increase in health care expenditures with increasing age will be due at least primarily to the acceleration of expenditures at the end of life and the increased mortality of aged individuals.

We have concerns, however. The descriptive statistics (presented in Table 1) demonstrate skewness in the sample in respect to health care expenditures by payer and service types. Medians are most appropriate for skewed data. A few individuals in the upper tail of the distribution could greatly affect the means.

In addition, the last year of life clearly contains two different distributions: the first 8 months and the final 4 months. This is an important distinction, yet it is buried in the figures and not presented in the tables. We would be interested in knowing what the median expenditures for the first 8 months and the final 4 months of the last year of life are for the decedent cohort. It would have been ideal if this information had been presented in two subcolumns in Table 1. We suspect the median figures will be nearly identical when the survivor group is compared with the group that is 12 to 4 months from death. This is a particularly important distinction for the figures presented in the article, because the annual figure implies that each month has the same expenditure.

Acknowledgments

Address correspondence to Kathryn Barzilai, Louis Stoke VA Medical Center, GRECC, 10701 East Blvd., Cleveland, OH 44106. E-mail: Kathryn.barzilai{at}med.va.gov

Reference

• Yang, Z., Norton, E. C., Stearns, S. C. 2003. Longevity and health care expenditures: The real reasons older people spend more. Journal of Gerontology: Social Sciences, 58B,S2-S10.

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