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. 2023 Sep;24(7):1047-1060.
doi: 10.1007/s10198-022-01532-z. Epub 2022 Oct 17.

Estimating healthcare expenditures after becoming divorced or widowed using propensity score matching

Iris Meulman  1   2 , Bette Loef  3 , Niek Stadhouders  4 , Tron Anders Moger  5 , Albert Wong  6 , Johan J Polder  7   8 , Ellen Uiters  3
Affiliations

Estimating healthcare expenditures after becoming divorced or widowed using propensity score matching

Iris Meulman et al. Eur J Health Econ. 2023 Sep.

Abstract

Becoming divorced or widowed are stressful life events experienced by a substantial part of the population. While marital status is a significant predictor in many studies on healthcare expenditures, effects of a change in marital status, specifically becoming divorced or widowed, are less investigated. This study combines individual health claims data and registered sociodemographic characteristics from all Dutch inhabitants (about 17 million) to estimate the differences in healthcare expenditure for individuals whose marital status changed (n = 469,901) compared to individuals who remained married, using propensity score matching and generalized linear models. We found that individuals who were (long-term) divorced or widowed had 12-27% higher healthcare expenditures (RR = 1.12, 95% CI 1.11-1.14; RR = 1.27, 95% CI 1.26-1.29) than individuals who remained married. Foremost, this could be attributed to higher spending on mental healthcare and home care. Higher healthcare expenditures are observed for both divorced and widowed individuals, both recently and long-term divorced/widowed individuals, and across all age groups, income levels and educational levels.

Keywords: Divorce; Healthcare expenditure; Healthcare utilization; Marital status change; Propensity score matching; Widowhood.

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Conflict of interest statement

The authors have no competing interests to declare that are relevant to the content of this article.

Figures

Fig. 1
Fig. 1
Flowchart of study population
Fig. 2
Fig. 2
Differences in sum of total healthcare expenditures from 2014 to 2017 stratified by whether or not an individual remarried within 4 years after marital dissolution
Fig. 3
Fig. 3
Differences in sum of total healthcare expenditures from 2014 to 2017 stratified by A highest level of completed education and B standardized disposable household income quintile
Fig. 4
Fig. 4
Differences in sum of total healthcare expenditure from 2014 to 2017 stratified by sex
Fig. 5
Fig. 5
A Difference in the probability of expenditures for different types of healthcare (odds ratio) from 2014 to 2017 between the groups of individuals who experienced a change in marital status and the matched long-term married group B Difference in expenditures among users (rate ratio) for the groups of individuals who experienced a change in marital status and the group that remained married. Maternity care applies to women at the age of 25–44 only
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