Older Americans are more likely than their peers in 10 other wealthy Western nations to have health problems and face difficulty paying for care, according to a study published in Health Affairs.
For the study, researchers used data from the 2017 Commonwealth Fund International Health Policy Survey of Older Adults. The survey involved 23,000 respondents, including between 500 and 7,000 people over 65 in each country selected for assessment. Specifically, in addition to older residents in the United States, the researchers looked at older residents of:
- The Netherlands;
- New Zealand;
- Switzerland; and
- The United Kingdom.
The researchers found that one in eight survey respondents reported having at least three chronic conditions. The United States had the highest rate, with 36% of elderly Americans reporting at least three chronic conditions. In comparison, Australia, the Netherlands, Norway, and Switzerland all had a rate of 17%, and New Zealand had the lowest rate at 13%.
The researchers also found U.S. respondents were more likely to skip care because of cost. Specifically, 23% of respondents from the United States said they had skipped going to the doctor despite being sick, had skipped a recommended medical test or treatment, or had not filled a prescription because it was too expensive. "In contrast, only 5% or fewer of older adults in France, Norway, Sweden, and the United Kingdom reported these cost barriers," the researchers wrote.
Older U.S. residents (25%) also were more likely than their peers in Norway (4%) and Sweden (3%) to report being concerned about having sufficient funds to cover basic necessities, such as food and housing. When the researchers assessed three other cost-related concerns, they found:
In addition, the researchers found that older U.S. residents faced significant obstacles to accessing timely care, although the United States performed better than at least one other nation for each of three measures:
Meanwhile, according to the researchers, older U.S. residents were significantly more likely to have reported an avoidable ED visit:
The researchers hypothesized that older U.S. residents may be more likely to report several chronic conditions than their peers in the other surveyed nations because they face gaps in health insurance coverage during their working years. As a result, the researchers suggested, U.S. residents are more likely to already have unmanaged chronic conditions when they age into Medicare coverage.
Further, the researchers suggested that older U.S. residents may be more likely to encounter financial barriers to care because the Medicare system requires premium contributions and cost sharing along with potentially high costs for prescription drugs. In contrast, other countries such as Canada, the Netherlands, and the United Kingdom offer universal coverage for older residents without deductibles or cost-sharing requirements for primary care, MarketWatch reports. Meanwhile, France permits adults with chronic conditions to forgo cost-sharing payments and prescription co-payments, while Sweden and Germany cap cost-sharing payments for certain beneficiaries.
According to the researchers, seniors in the United States also face obstacles to receiving basic social services, which could result in their higher rate of ED visits and hospitalization. By comparison, Canada has invested more in both home- and community-based care, and Australia has programs that provide home care, meals, and palliative care for the elderly (Thielking, STAT News, 11/17; Mangan, CNBC, 11/15; Malito, MarketWatch, 11/16).
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