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International Survey of Older Adults Finds Shortcomings in Access, Coordination, and Patient-Centered Care

global health


A survey of older people in 11 countries finds that U.S. adults are sicker than their counterparts abroad, as well as the most likely to have problems paying their medical bills and getting needed healthcare. U.S. adults also reported difficulty getting care in a timely fashion and using emergency departments for issues that a primary care physician could treat. Among the bright spots for the United States: having a care plan for chronic illness, and planning for end-­of-­life care.

The Issue

Across the developed world, national health systems must contend with caring for aging populations with high rates of disability and chronic disease. Because so many receive care from several providers, manage a complex care regimen, and take multiple prescription medications, older people face particularly high exposure to health system flaws that can result in physical harm as well as higher costs. The Commonwealth Fund surveyed adults age 65 or older in 11 countries to understand how well health systems are caring for older adults, where the gaps in performance are, and how policy reforms can make a difference.

Key Findings

  • The United States stands out for having the highest rates of chronic health conditions, such as diabetes and heart disease: 87 percent of older adults in the U.S. reported at least one chronic illness,and 68 percent reported two or more.
  • Despite having Medicare coverage, U.S. adults age 65 or older were the most likely to report that cost posed a barrier to care. One-fifth (19%) said cost was the reason they did not visit a doctor, skipped a medical test or treatment recommended by a doctor, did not fill a prescription, or skipped doses.
  • U.S. survey respondents were also the most likely to report trouble paying their medical bills (11%). Only 1 percent in Norway and Sweden reported the same.
  • Canadian, Swedish, Norwegian, and U.S. respondents were the least likely to be able to get a same- or next-day doctor’s appointment when sick or to find it somewhat or very easy to get after-hours care without using the emergency department.
  • Older adults in all countries face care coordination and safety problems. In the U.S., 35 percent reported at least one problem with care coordination, such as not having a recommended medical test, receiving conflicting information from different doctors, or experiencing a lack of communication between a primary care doctor and a specialist. In every country but France, one-fifth or more of older adults have experienced at least one of these problems.
  • Along with the U.K., the U.S. did well in areas related to managing chronic illness: 58 percent of chronically ill older adults in the U.S. and 59 percent in the U.K. had discussed their treatment goals with their doctor and had clear instructions about when to seek further care. Fewer than half of chronically ill people in the other nine countries said the same.
  • More than three-quarters (78%) of older adults in the U.S. said they reported talking to a family member, friend, or health professional about their care preferences if they become unable to make decisions for themselves. Two-thirds said they had a written plan naming a health care proxy and more than half (55%) said they had a written plan regarding the treatment they want at the end of life.

The Big Picture

"Despite having Medicare coverage, older U.S. adults remained much more likely to face financial barriers to care than their counterparts in other developed countries.”


U.S. older adults were much more likely to face financial barriers to care than their counterparts abroad, the author say. Despite Medicare coverage, older Americans have less protection from health care costs, primarily because of high deductibles and copayments, especially for pharmaceuticals, and limitations on catastrophic expenses and long-term care coverage.

About the Study

The 2014 Commonwealth Fund International Health Policy Survey of Older Adults was conducted by phone from March through May 2014. More than 15,000 people age 65 or older took part in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.

The Bottom Line

Compared with their counterparts in 10 other industrialized countries, older adults in the U.S. are sicker and more likely to have problems paying their medical bills and getting needed health care.


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Publication Details



Mary Mahon, Former Vice President, Public Information, The Commonwealth Fund

[email protected]


R. Osborn, D. Moulds, D. Squires, M. M. Doty, and C. Anderson, "International Survey of Older Adults Finds Shortcomings in Access, Coordination, and Patient-Centered Care," Health Affairs Web First, published online Nov. 19, 2014.