A new international study published in the current issue of Health Affairs indicates that universal health care systems, including Medicare in the United States, effectively provide quality care to the elderly. Respondents age 65 and older in five countries—Australia, Canada, New Zealand, the United Kingdom, and the United States—praised the quality of care and the ease of access to services. At the same time, many also expressed grave concern over the ability of the health systems to meet their needs in the future. In the United States, the cost of prescription drugs was of particular concern. "Elderly Americans fare surprisingly well compared with the elderly in other countries," said Karen Davis, president of The Commonwealth Fund. "These results reveal that Medicare goes a long way toward assuring access to health care for older populations—in stark contrast to adults under age 65, where the U.S. lags behind other countries." Davis also said the results suggest that Medicare has helped many frail elderly people obtain home health care at a rate better than other countries in the study. The major disparity is in access to prescription drugs, which are not covered by Medicare. "The Elderly in Five Nations: The Importance of Universal Coverage" is based on findings from The Commonwealth Fund 1999 International Health Policy Survey. Conducted by Harris Interactive, Inc., the survey examines the health care attitudes and experiences of people age 65 and older in each of the five nations. The study was conducted by Karen Donelan and Robert J. Blendon of the Harvard University School of Public Health, and Cathy Schoen, Robin Osborn, and Karen Davis of The Commonwealth Fund, and Katherine Binns of Louis Harris, Interactive. Additional findings from the survey were also released today in a new Fund report, The Elderly's Experiences with Health Care in Five Nations, available in full on the Internet at www.commonwealthfund.org/programs/international/schoen_5nat_387.pdf. Elderly Voice Concerns about Their Health Systems Many of the elderly expressed concerns about the future of their own health care. One of five (19%) elderly Americans are "very concerned" they will become a burden to their family, as are one of four (25%) New Zealanders and 13 percent each of residents of Australia, Canada, and the United Kingdom. In four countries, more respondents said that health care for the elderly had declined rather than improved over the past five years. The exception was the United Kingdom, where more respondents said health care for the elderly had improved rather than declined. In every country except the United Kingdom, more than one of four elderly respondents expressed negative views about their country's health system. The United States was the only country in which the elderly were more positive about the system than younger people. Americans 65 and older were significantly less likely than younger adults to say the health system has so many problems that it needs to be completely redesigned (27% vs. 34%). The elderly in Australia and New Zealand were most likely to express negative views, while elderly U.K. respondents were least likely to call for systemwide change. The views of the elderly in Canada and the United States fell between those two extremes. Access and Cost Receive High Marks The elderly in all five countries do not often report difficulty getting needed medical care: fewer than 15 percent of respondents in all countries cited such problems. The U.S. rate is within the range of the other four countries with universal health care, indicating that Medicare is effective in assuring basic care for the elderly. The United States does, however, have a wide disparity between older and younger people on this question: Americans under age 65 are twice as likely to have difficulties getting medical care as those 65 and over (30% vs. 15%). The cost of care does not appear to be a major problem for the elderly, either; fewer than 6 percent in any country said they had problems paying medical bills. "In many measures of access to and cost of care, the United States looks much like these other nations—a testament to the protections offered by Medicare," stated Karen Donelan, lead author of the Health Affairs article. Views on the quality of care were also generally positive. At least one of four elderly in each country rated the medical care they received in the past year as excellent, and from one-third to one-half of respondents rated their last doctor visit as excellent. Lack of Prescription Drug Coverage in U.S. Is Cause for Concern A key difference between health care for the elderly in the United States and the four other nations surveyed is the lack of prescription drug coverage. Not surprisingly, there is a wide disparity in the relative burden of out-of-pocket costs for drugs between the elderly in the United States and the elderly in other countries. One of five (20%) of the U.S. elderly pay from $50 to $100 out-of-pocket per month for drugs, and more than one of six (16%) pay over $100 per month. In contrast, fewer than 5 percent of the elderly in the other four countries had prescription drug costs totaling more than $100. High drug costs are associated with difficulty meeting basic living expenses such as food, housing, and transportation. Of those U.S. elderly with high out-of-pocket drug costs (over $100 per month), a striking proportion—three of 10 (29%)—have problems meeting daily living expenses.