Older adults in the United States are sicker than their peers in 10 other developed countries and also find it more difficult to get timely and affordable health care and to pay their medical bills, according to the results of a new study.
The study also found, however, that American older adults are more likely than their counterparts in those other 10 countries to have relatively quick access to a medical specialist, to have discussed health-promoting behaviors like diet and exercise with their physician, to have a chronic-care plan designed to fit their daily life and to have engaged in end-of-life care planning.
The study is based on results from a survey conducted earlier this year by the Commonwealth Fund and published online Wednesday in the journal Health Affairs. It involved more than 15,000 adults aged 65 and older from 11 countries (Australia, Canada, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States). Those countries offer what the study’s authors call a “kaleidoscope of funding models, from tax-funded national health systems to national insurance systems with competing regulated private health insurance plans, some operating through so-called health insurance Marketplaces or their equivalent.”
The survey’s U.S. respondents were, of course, covered by Medicare.
Health officials from all of the 11 countries that took part in the survey are actively trying to figure out how to redesign their health-care systems to meet the needs of their aging populations, the study’s authors point out.
“With older patients often receiving care from multiple providers, taking multiple prescription drugs, and managing complicated care regimens, these people are vulnerable to health system failures that can result in fragmented and poorly coordinated care, as well as costly and injurious medical errors,” the researchers explain.
More illnesses, more medications
Here are the survey’s key findings for older adults in the U.S. First, the not-so-good news:
- Most people surveyed had at least one chronic health condition, such as heart disease, high blood pressure, diabetes or arthitis. But the U.S. had the highest rate of such conditions: 87 percent of the survey’s U.S. respondents reported at least one chronic health condition and 68 percent reported two or more. In Great Britain, by comparison, only 33 percent of older adults reported having multiple chronic health problems.
- Older adults in the U.S. are taking more medications than their counterparts elsewhere. More than 53 percent of the survey’s U.S. respondents said they were taking four or more medications. The country with the next-highest percentage of older adults taking four or more medications was New Zealand (44 percent). France and Switzerland tied with the lowest percentages (29 percent).
- Despite having access to Medicare’s universal coverage, almost one-fifth (19 percent) of the survey’s U.S. respondents said that cost had kept them from visiting a doctor or getting a medical test or filling a prescription during the previous year. In addition, 21 percent of the U.S. respondents said they had spent more than $2,000 of their own money for care during the previous year, and 11 percent said they had experienced problems paying their medical bills (or couldn’t pay them at all). A similar proportion of older adults in Switzerland (22 percent) also said they spent more than $2,000 out of pocket on medical care, but only 2 percent said they had trouble paying those bills. In most of the countries, fewer than 10 percent of older adults said cost was a barrier to care.
- The U.S. respondents, along with those from Canada and Sweden, reported having the most difficulty getting same-day or next-day appointments with their doctor when ill. They were also the most likely to report going to the emergency department of a hospital for an illness that they thought could have been handled by their own doctor, if he or she had been available. By contrast, more than 80 percent of respondents in Germany, France and New Zealand said they had no problem getting same-day or next-day access to their doctor.
- Coordination of care is important, particularly for people with multiple medical conditions. The survey found that the U.S. respondents were the most likely to report that their medical records or test results had not been available at a scheduled doctor’s appointment or that they had been given duplicate tests (23 percent). That compared with 17 percent or less of the respondents from the other countries.
These findings demonstrate, say the study’s authors, that “despite having Medicare coverage, older US adults remained much more likely to face financial barriers to care than their counterparts in other developed countries. This may be surprising, as other studies have found that Medicare offers more stable and protective insurance than other forms of coverage in the United States, including employer-sponsored private coverage. However, it is still clearly less protective than the universal coverage offered in the health systems of other countries surveyed.”
Quicker access to specialists
And now for the survey’s better news for older adults in the U.S:
- The United States, along with Switzerland, had the greatest number of respondents (86 percent and 83 percent, respectively) who said they were able to see a medical specialist within four weeks.
- U.S. respondents were the most likely to report that their doctor had discussed with them how to live a healthy life. Some 76 percent said they had been advised about diet and exercise, and 29 percent said their doctor had talked with them about reducing stress.
- The United States also “stood out,” say the study’s authors, for the number of respondents who said they had discussed advance care planning with their doctor (78 percent) and who said they had a written plan regarding the end-of-life care they wished to receive (55 percent).
- The United States — along with Great Britain — was also a top performer in the survey when it came to doctors discussing care goals with their patients. Among chronically ill respondents, 58 percent of those in the U.S. and 59 percent of those in the U.K. said their doctor had explained those goals with them and given them clear instructions on when to seek further care.
One final finding: As many as one in four of the survey’s chronically ill respondents in the United States, as well as in several other countries, were themselves caregivers — “a reminder,” say the study’s authors, “of how interwoven health and social care needs can be in this population.
You can read the study in full on the Health Affairs website.