Commonwealth Fund report reveals stark comparison to 10 industrialized countries with universal health coverage
By Steven Reinberg
HealthDay News, Nov. 19, 2014
Seniors in America have more chronic health problems and take more medications than seniors in 10 other industrialized countries do, according to a new global survey.
The United States also stood out among the 11 nations surveyed by The Commonwealth Fund for having more seniors struggling to get and afford the health care they need.
Eighty-seven percent of U.S. adults who are 65 and older suffer from at least one chronic illness, and 68 percent have at least two illnesses, which were the highest rates found, the survey showed. Also, 53 percent of older Americans take at least four medications, another record high, and 21 percent spend at least $2,000 in yearly out-of-pocket health care costs, which was second only to Switzerland.
“The retirement of baby boomers means pressure on Medicare will intensify,” Dr. David Blumenthal, president of The Commonwealth Fund, said during a news briefing Tuesday to announce the study findings, which were published online Nov. 19 in the journal Health Affairs.
Despite the moderating of health care costs in recent years, Blumenthal added, “Costs are still going up too fast to be sustainable over the long term, and this will be exacerbated by increasing numbers of elderly individuals.”
The study’s lead author and Commonwealth Fund vice president, Robin Osborn, noted at the news briefing: “Those over 65 in the U.S. will almost double from 2005 to 2030. These sicker adults will likely put a strain on the health care system [which] will need to transform to meet the challenges of an aging population.”
For the survey, the researchers collected 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 United States.
Most all of the other countries have some form of universal health insurance, and American seniors have Medicare, but Osborn said striking differences emerged in the survey:
- Although the U.S. senior group was the youngest of all the countries in the report, they were also among the sickest: 25 percent of older Americans saw at least four doctors in the past year, second only to Germany at 39 percent.
- In addition, more Americans (19 percent) said they skipped essential health care because they could not afford it, and 11 percent said they had trouble paying their medical bills. In France, only 3 percent of seniors said they skipped health care because of cost, and in Norway only 1 percent said they had trouble paying medical bills.
- In terms of out-of-pocket costs, only the Swiss spent more than Americans. In the United States, 21 percent spent $2,000 or more a year, compared with 22 percent in Switzerland and 2 percent in the United Kingdom. In France, on the other hand, virtually no one spent out-of-pocket costs.
- Only 57 percent of U.S. seniors said they were able to see their doctor the same or the next day when they were sick, compared with 83 percent in France and New Zealand, and 81 percent in Germany.
- Americans use of emergency rooms was one of the highest, at 39 percent. Thirty-five percent of these visits were for conditions their doctors could have dealt with had they been available, the researchers found.
- When a specialist was needed, 86 percent of U.S. seniors and 82 percent of seniors in Switzerland were able to see one within four weeks — the highest rates in the survey. Seniors in Canada (46 percent), Norway (46 percent) and Sweden (50 percent) were the least likely to get appointments that quickly.
- U.S. seniors, like seniors in the other countries, appear to suffer from poorly coordinated care or gaps in communication between doctors: 35 percent of U.S. seniors reported having such problems, as did 41 percent in Germany and 37 percent in Norway. In France, only 7 percent said they had these problems. But, the survey showed, American seniors also had better doctor/patient relationships than seniors in many other countries.
An expert who was not involved with the study had a simple explanation for the key findings on American senior illnesses.
Dr. Steffie Woolhandler, co-founder of Physicians for a National Health Program, said American seniors are sicker because of the inadequate care they received before they turned 65.
“The health care system for the under-65 population is full of gaps, and lots of people fall through the cracks,” she said.
Woolhandler, who is also a professor of health at CUNY School of Public Health at Hunter College in New York City, added that Medicare is also leaving many Americans underinsured and that the Affordable Care Act will not make a major difference.
“We need to be providing much more comprehensive coverage to everyone, including lower co-pays and deductibles,” she suggested.
SOURCES: Steffie Woolhandler, M.D., professor, CUNY School of Public Health, Hunter College, New York City, and co-founder, Physicians for a National Health Program; Nov. 18, 2014, news conference with: David Blumenthal, M.D., president, and Robin Osborn, vice president and director, International Program in Health Policy and Practice Innovations, both Commonwealth Fund; Nov. 19, 2014, Health Affairs, online