Patterns of Healthcare Costs Among Older Adults: Demographics, Health Personality, and Resilience

The purpose of this study was to examine healthcare costs of older adults in relation to demographic characteristics, individual health personality traits, and resilience. Data included 3,907 participants, 65 and older, collected by a large provider of Medicare Supplemental Health Insurance. The Health Personality Assessment*, Brief Resilience Scale, total healthcare cost, and demographic information were used. In our sample, the average healthcare cost was $13,283.69 (SD=30,784.87), ranging from $0–$989,084, and higher healthcare costs were found among older, male, and less health-neurotic (i.e., lower health-related anxiety) adults. Configural frequency analyses were conducted to identify “types” and patterns of healthcare costs by age and gender. The following significant patterns emerged: Women in the oldest group with high healthcare costs and women in the young-old age group who had low healthcare costs occurred significantly more than expected by chance, p<.01. Next, we hypothesized configuration patterns for resilience, health personality, and healthcare costs. Results confirmed the following “types” or patterns occurring more often than expected by chance: less-resilient individuals with high health neuroticism and high healthcare costs, p<.001, and less-resilient, less-health-conscientious adults with high healthcare costs, p<.001. The results suggest higher healthcare costs for individuals who are less resilient, more neurotic about their health, and less disciplined in their health practices. Future intervention programs may benefit from promoting resilience, reducing health neuroticism, and increasing health conscientiousness. *The Health Personality Assessment (HPA) is © 2021 United HealthCare Services, Inc. All rights reserved.

Voluntary private health insurance, health-related behaviours and health outcomes: evidence from Russia

This paper contributes to the discussion around ex-post (increased utilisation of health care) and ex-ante (changes in health behaviours) moral hazard in supplemental private health insurance. Applying a range of methodologies to data from the Russian Longitudinal Monitoring Survey—Higher School of Economics we exploit a selection mechanism in the data to compare the impact of workplace provided and individually purchased supplemental health insurance on the utilisation of health care, on a range of health behaviours and on self-assessed health. We find compelling policy-relevant evidence of ex-post moral hazard that confirms a theoretical prediction and empirical regularity found in other settings. In contrast to other empirical findings though, our data reveals evidence of ex-ante moral hazard demonstrated by clear behavioural differences between those with self-funded supplemental health insurance and those for whom the workplace finances the additional insurance. We find no evidence that either form of insurance is related to improved self-assessed health.

Predicting Perceived Health of Older Adults: The Role of Health, Personality, and Resilience

Past research has not addressed how domain-specific “health” personality traits are associated with resilience and well-being. The purpose of this study was to determine pathways from health personality to perceived health, mediated by resilience. Data included 3,907 participants, 65 and older, collected by a large provider of Medicare Supplemental Health Insurance. The Health Personality Assessment (health neuroticism, health extraversion, health openness, health agreeableness, and health conscientiousness), Brief Resilience Scale, and perceived health were measured. Structural equation modeling and bootstrap mediation were conducted in Mplus. The hypothesized model resulted in a marginal fit, so direct paths from health openness and health conscientiousness to perceived health were added, resulting in an improved fit, χ2(192)=1660.96, RMSEA=.04, CFI=.95; χ2∆(2)=403.99, p<.001. Health neuroticism and health extraversion negatively predicted perceived health, fully mediated by resilience, β=-.11, p<.001, and β=-.01, p<.05, suggesting that people anxious about their health or that talk about their health had significantly lower levels of resilience. Resilience positively predicted perceived health, indicating that more resilient people reported better health. Higher levels of health openness predicted significantly lower levels of perceived health, β=-.19, p<.001. Greater levels of health conscientiousness predicted better perceived health, β=.20, p<.001, and resilience in-turn positively related to perceived health, β=.08, p<.001. Health personality and resilience explained 25.3% of variance in perceived health. This study exemplifies the importance of health personality and resilience in predicting perceived health for older adults. Future research should examine interventions focused on health personality increasing resilience, as older adults with higher resilience reported significantly better health.

Health Personality, Consumer Health Activation, and Loneliness

The purpose of this study was to identify relationships between health personality traits, consumer health activation (CHAI) and loneliness. Data for these analyses were collected by a large provider of Medicare Supplemental Health Insurance. The study consisted of 3,907 participants, 65 years and older. Participants were surveyed on health personality (e.g., Health Neuroticism, Health Extraversion, Health Openness, Health Agreeableness, and Health Conscientiousness), Consumer Health Activation, and Loneliness. Structural equation modeling and mediation were conducted through Mplus. The hypothesized model fit without direct paths from health personality to loneliness was not optimal. Adding direct paths from health neuroticism, health openness, and health agreeableness to loneliness resulted in an excellent fit, □2 (5) = 0.86, RMSEA = 0.00, CFI = 1.00. Health neuroticism and health openness were negatively related to health activation, which suggests respondents were less likely to be active about their health. Alternatively, health agreeableness and health conscientiousness were positively related to health activation, indicating more health activation. Mediation was tested for pathways from health personality dispositions to loneliness through health activation. The results suggest individuals higher in health neuroticism or health openness were less activated, which in turn indicated higher loneliness. Moreover, those higher in health agreeableness or health conscientiousness were more activated and indicated less loneliness. This study provides an understanding about loneliness through health personality and health activation. Future research should explore interventions for older adults with specific health personalities, or health activation to reduce loneliness levels.