Does widowhood explain gender differences in out-of-pocket medical spending among the elderly?

J Health Econ. 2013 May;32(3):647-58. doi: 10.1016/j.jhealeco.2012.10.011. Epub 2012 Nov 12.


Despite the presence of Medicare, out-of-pocket medical spending is a large expenditure risk facing the elderly. While women live longer than men, elderly women incur higher out-of-pocket medical spending than men at each age. In this paper, we examine whether differences in marital status and living arrangements can explain this difference. We find that out-of-pocket medical spending is approximately 24 percent higher when an individual becomes widowed, a large portion of which is spending on nursing homes. Our results suggest a substantial role of living arrangements in out-of-pocket medical spending. Our estimates combined with differences in rates of widowhood across gender suggest that marital status can explain about one third of the gender difference in total out-of-pocket medical spending, leaving a large portion unexplained. On the other hand, gender differences in widowhood more than explain the observed gender difference in out-of-pocket spending on nursing homes.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Female
  • Financing, Personal / statistics & numerical data*
  • Humans
  • Male
  • Medicare / economics
  • Nursing Homes / economics
  • Sex Factors
  • United States
  • Widowhood / statistics & numerical data*