The Good, the Bad & the Ugly: How Does US Health Care for Older Adults Stack Up?

How do the health care experiences of older adults in the United States compare to older adults in other industrialized countries? A survey of 15,617 community-dwelling adults in 11 countries aimed to find the answers. This survey asked adults 65 and better about access to care, chronic conditions, care coordination, patient engagement, social care needs, and end-of-life planning. Since Medicare provides near-universal coverage of adults over 65 in the United States, all of the participants surveyed have broad access to care.

Across all countries, the majority of surveyed adults had at least one chronic condition. However, the United States stood out as having the highest rate of chronic conditions, with 87 percent having at least one, and 68 percent having 2 or more. No other country had greater than 50 percent reporting having more than one chronic condition. Moreover, the percentage of older adult taking four or more prescriptions was also much higher in the United States, at 53 percent, compared to between 29 and 44 percent in other countries.

The only countries that had greater than 50 percent of participants with chronic conditions reporting that health care professionals had discussed their main goals and symptoms to watch for were the United States (58 percent) and the United Kingdom (59 percent). The United States also had the highest percentage of participants with chronic conditions reporting that they had a treatment plan for their condition that they could carry out in their daily life (83 percent). The highest percentage of participants who reported that they had a health professional that they could contact between doctor visits was also from the United States, at 84 percent.

Promotion of a healthy lifestyle by doctors was another area of health care which was more common in the United States than other countries. Seventy-six of US participants reported that a health care professional had discussed healthy diet and exercise with them in the past two years, and 29 percent had a health professional discuss things that can cause stress.

The United States had the second highest percentage of people who had seen four or more doctors in the past year, at 25 percent. As for timeliness of care, US, Canadian, and Swedish participants were the least likely to be able to get a same-day or next-day appointment when sick. These participants were also the most likely to have gone to the emergency room; participants indicated that some of these visits were for conditions that could have been treated by a regular doctor if only one were available. However, US participants (86 percent) were most likely to be able to get an appointment with specialists within four weeks.

For care received and care coordination, US participants were the most likely to report medical records not being available at an appointment or having tests duplicated. US participants were also the most likely to report receiving conflicting information from different doctors.

Despite Medicare, 19 percent of American participants still reported cost being a reason for not visiting a doctor, skipping a recommended treatment, not taking or filling prescriptions, or skipping doses of medications. This is almost double the percentage of the next highest country, New Zealand. Twenty-one percent also reported having paid over $2,000 out of pocket. For most of the other countries surveyed, less than 10 percent reported having spent over $2,000 out of pocket.

Overall, this survey presents a US population that is struggling with some aspects of health care when compared to other industrialized countries. In particular, the United States stands out as having poor access to primary care, and a greater dependence on emergency room care, as well as showing large gaps in care coordination. Despite Medicare, health care still poses more financial challenges for US patients than those from other countries. Moreover, US participants reported having a greater number of chronic diseases than individuals from other countries. Such a disease burden combined with access to primary care and the high levels of emergency room usage pose a significant policy challenge for the United States. The United States already significantly outspends all other countries in this survey (often by a greater than two-to-one margin), and yet this study shows numerous health gaps that the United States should work to narrow between itself and other countries.

However, it should not be overlooked that there are some bright spots in the US health care system compared to other countries. For one thing, US patients also have better access to specialists than is reported by other countries. The US also stands out in terms of receiving guidance about managing chronic conditions and on lifestyle factors that impact health. This suggests that more Americans are receiving communication from health care providers that could assist them in managing their health. This could lead to better health outcomes for those who follow such advice, but the adherence to recommendations was not investigated in this study.

Overall, a comparative survey like this one gives us an idea of where room for improvement exists, as well as an idea of where to look for examples of health care systems that are succeeding. There are areas in which other countries can look to the United States for ideas on how to improve, and the United States could also benefit from investigating how other countries are achieving the health care successes reported here.



Osborn R, Moulds D, Squires D, et al. International survey of older adults finds shortcomings in access, coordination, and patient-centered care. Health Affairs. (2014). DOI: 10.1377/hlthaff.2014.0947