America’s Senior Care Gets Low Marks Versus Global Peers

When it comes to affording and receiving much-needed health care, older Americans are in worse shape compared to some of the world’s leading nations, according to the results from a new international survey.

In the U.S., adults age 65 and older are sicker and more likely to struggle paying medical bills and getting the health care they need compared to their counterparts in 10 other industrialized countries, says the survey from The Commonwealth Fund, a private foundation that provides grants to support independent research focused on improving health care practice and policy.

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


While the study notes that all of the surveyed countries could do better to improving conditions for their elderly populations, The Commonwealth Fund found that the U.S. was home to the sickest of seniors.

Of the Americans age 65 and older who participated, the survey found 87% have at least one chronic illness, while 68% have two or more—the highest rates among the 11 countries analyzed. 

Additionally, more than half (53%) of U.S. respondents reported taking four or more medications—also the highest among other nations—and 25% of American seniors saw four or more doctors in the past year, second only to Germany (39%). 


The U.S. also stood out for having the most 65 and older adults reporting they skipped needed health care because of costs (19%). Moreover, these older adults were also most likely to report they had trouble paying for their medical bills (11%).

In contrast, only 3% of older adults in France skipped health care due to cost-related struggles, while only 1% in Norway and Sweden said they struggled to pay medical bills. 

U.S. seniors’ cost woes aren’t necessarily unfounded as older Americans spend more than their counterparts 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,” said The Commonwealth Fund.

To further illustrate this point, the survey found that 21% of seniors spend $2,000 or more a year out-of-pocket on health care, a higher rate than any other country except Switzerland, where 22% spent that much. In the U.K., only 2% spent more than $2,000 or more per year, while virtually no one did in France.

Despite paying more, U.S. adults also were less likely to have timely access to the health care they need compared to the other nations.

Only 57% of older adults in the U.S. reported they could get a same- or next-day doctor’s appointment, compared to 83% in France and New Zealand, and 81% in Germany.

Inaccessibility also led to more emergency room visits for this population, with more than a third (35%) doing so for a condition their primary doctor could have treated had he or she been available.

When it came to coordination of care, people in nearly every country reported experiences with either poorly coordinated care of gaps in communication between providers. 

Countries where older adults experienced the some of the highest rates of care coordination problems were Germany, Norway, and the U.S.—41%, 37% and 35% respectively. Such problems included not having a recommended medical test, receiving conflicting information from different doctors, or having a specialist and primary care doctor not communicating. 

The survey was not entirely all U.S. bashing, as it did spotlight several areas where the nation did better than average, or at least kept pace with the majority of the other countries, especially when it came to management of chronic illness, patient-doctor communication, hospital-to-home transitions and end-of-life planning.

About 58% of chronically ill older adults in the U.S. reported they had discussed their treatment goals with their doctors and had clear instructions about when to seek further care. Fewer than half of chronically ill people in the other nations reported the same, with the exception of the U.K. (59%).

The vast majority of older Americans (86%) also reported that their doctor spent enough time with them.

Furthermore, the U.S. had among the lowest rates of seniors reporting gaps in their discharge-planning when leaving the hospital to return home. Only about 28% of American seniors reported discharge arrangement gaps, such as not having written instructions or not knowing what symptoms to watch out for, or whom to contact with a question when they left the hospital. 

For end-of-life planning, older adults in the U.S. were the most likely to have taken proactive steps to express their care preferences in the event they become unable to make decisions for themselves, with 78% reporting they had discussed this with a family member, friend or health professional.

Additionally, 67% reported having a written plan naming someone to make their health decisions for them, while 55% said they have a written plan describing the treatment they want at the end of life. 

“This new survey shows that there are three areas, such as manning patients who have chronic illnesses and hospital discharge planning, where the U.S. does well compared to other countries,” said Robin Osborn, the study’s lead author and vice president and director for The Commonwealth Fund’s International Program in Health Policy and Practice Innovations. “However, older Americans struggle more to get and afford the health care they need, indicating the need to improve Medicare’s financial protections.”

Although there is still much room for improvement for the U.S., as well as among other nations, it is encouraging to see the U.S. health system doing well for older adults in areas like better managing chronic illness, which have been the focus of concentrated efforts for improvement, 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,” Blumenthal said. 

Access the survey.

Written by Jason Oliva

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