Despite Medicare, Financial Barriers to Care Plague Older U.S. Adults

People in the U.S. over the age of 65 are more likely to be sick and more likely to have problems paying for the cost of health care than similarly aged counterparts in 10 other industrialized nations, according to the findings of a survey published by The Commonwealth Fund. The survey, which asked people 65 and older from 11 different industrialized countries about their health and financial access to care, revealed that the U.S. falls behind in almost every category, when compared to other industrialized countries.


According to a Commonwealth Fund press release, the survey analyzed responses from 15,000 older adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the U.S. According to the release, the study offers an interesting view into the comparative effectiveness of Medicare, because the older adults in each of the other high-income countries surveyed have some form of universal health insurance coverage.

High Costs

Among the most notable of the findings were the financial costs that older adults in the U.S. face for health care, despite having access to the broad coverage of Medicare. For example, 21 percent of older adults in the U.S. spent $2000 or more a year in out-of-pocket costs for health care, while only 2 percent of older adults in the U.K. did. Similarly, while U.S. respondents were most likely to report difficulties paying medical bills, with 11 percent of older U.S. adults indicating reporting such financial troubles, only 1 percent of older adults in Sweden and Norway reported those problems.


Costs were also reported more often as a financial barrier to accessing care in the U.S. than they were in any of the other 10 nations, with 19 percent of U.S. adults 65 or older reporting they did not visit a doctor, skipped a medical test or treatment recommended by a doctor, did not fill a prescription, or skipped doses because of the cost of care. The reasons behind the higher costs, according the Commonwealth Fund, are “high deductibles and copayments, especially for pharmaceuticals, and limitations on catastrophic expenses and long-term care coverage.”


U.S. respondents reported relative difficulty getting same- or next-day doctor’s appointments, with only 57 percent saying they could obtain such appointments, while 83 percent in France and New Zealand, and 81 percent in Germany were able to be seen the same- or next-day. In a related matter, older adults in the U.S. were more likely to rely on the emergency department for care that a primary physician, if available, would have been able to provide. Specifically, 39 percent of older U.S. adults reported using the emergency department in the past two years and 35 percent of those adults indicated that they used the emergency department for something their primary doctor would have treated.


The survey did have some bright news for senior care in the U.S. For example, at 58 percent, older adults in the U.S. reported some of the highest rates of discussing treatment plans for chronic illnesses with their doctors. Less than half of chronically ill older adults in the other 10 countries, with the exception of the U.K., reported the same. Older U.S. adults also had a high prevalence of reporting that they had a treatment plan they could carry out in their day-to-day lives. High rates of positive patient-doctor communication, low occurrences of gaps or confusion in transitions from hospital to home, and high rates of end-of-life planning discussions were also reported by U.S. adults over 65. Specialty care appointments were another area where the U.S. excelled, with 86 percent of older U.S. adults saying they were able to get an appointment with a specialist in six weeks, which outranked the older adults in Norway and Canada, where only 46 percent of older adults could get a specialist appointment on the same timeline.