New York, NY, November 19, 2014—Eighty-seven percent of U.S. adults age 65 and older have at least one chronic illness and 68 percent have two or more, the highest rates in a new 11-country Commonwealth Fund survey whose findings were published today as a Health Affairs Web First. About half (53%) of the U.S. respondents reported taking four or more medications—the highest rate of the 11 countries. Moreover, 25 percent of older U.S. adults saw four or more doctors in the past year, second only to Germany (39%). The survey findings indicate that older Americans are sicker than their counterparts in the other countries, despite the fact that the U.S. population is the youngest.
The United States also stands out for having the most 65-and-older adults reporting they skipped needed health care because of costs (19%). U.S. older adults were also among the most likely to report they had trouble paying their medical bills (11%). In contrast, just 3 percent of older adults in France skipped health care because of costs, and only 1 percent in Norway and Sweden said they struggled to pay medical bills.
The Health Affairs article, “International Survey of Older Adults Finds Shortcomings In Access, Coordination, and Patient-Centered Care,” analyzes responses from more than 15,000 older adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the U.S. The study focused exclusively on the health care experiences of adults age 65 and over, providing a unique window, the authors say, into how Medicare beneficiaries in the U.S. compare to older adults in other high-income nations, all of which have some form of universal health insurance coverage.
“Previous surveys have shown that older people with Medicare coverage fare better than working-age adults in the U.S.,” said Robin Osborn, the lead author and Vice President and Director for The Commonwealth Fund’s International Program in Health Policy and Practice Innovations. “This new survey shows that there are areas, such as managing patients who have chronic illnesses and hospital discharge planning, where the U.S. does well compared to other countries. However, older Americans struggle more to get and afford the health care they need, indicating the need to improve Medicare’s financial protections.”
Older U.S. Adults Spend More Than Adults in Other Countries for Poorer Access to Health Care
Despite the near-universal coverage that Medicare provides, older U.S. adults in the survey incurred substantial out-of-pocket costs. Twenty-one percent spent $2,000 or more a year out-of-pocket on health care, a higher rate than any other country except Switzerland, where 22 percent spent that much. In the U.K., only 2 percent spent $2,000 or more, and in France, virtually no one did.
Although U.S. adults spent more, the survey found that they were less likely to have timely access to the health care they need:
People in Nearly Every Country Reported Poorly Organized Health Care
Older adults in every country surveyed reported some experiences with poorly coordinated care or gaps in communication between providers:
Bright Spots for U.S.
There were several areas in which the U.S. did better than average, or at least kept pace with the majority of the other countries:
“It is encouraging to see the U.S. health system doing well for older adults in areas that have been the focus of concentrated efforts to improve, such as better management of chronic illness,” said Commonwealth Fund President David Blumenthal, M.D. “Monitoring our progress over time and comparing it to other nations will be useful during the ongoing implementation of the Affordable Care Act, as more Americans gain health insurance coverage and further reforms are rolled out to improve how health care is delivered.”
The study notes that all of the countries in the survey could do better, and that it is worthwhile to monitor what is working and what isn’t as they innovate to improve health care and reduce costs for their aging populations.
In the U.S., the survey findings highlight some of Medicare’s challenges—high copayments and deductibles in many cases, and costs resulting from limitations on catastrophic expenses and long-term care coverage. But they also underscore how essential Medicare is to ensuring that older adults get the health care they need. As the country’s sicker adults over 65 continue to age and more baby boomers turn 65, the Medicare system will be strained, the authors warn. They note it will therefore be crucial to implement reforms that reduce health care costs and make sure our health care system is providing older adults with the best possible care.