Coming of Age

And it came to pass…Last week I signed up for Medicare in anticipation of my 65th birthday in a few months. It was an alphabet soup of choices that yielded a monthly savings of about $300 from my present plan, but did not include coverage for four of my biggest cost concerns heading toward retirement: dental, eye, hearing, and long-term care.
 
That got me thinking about coverage in other countries. Enter The Commonwealth Fund, which has been publishing surveys comparing health care in industrialized countries since 1998. A report they released at the end of 2014 in tribute to Medicare’s 50th anniversary focused on health care coverage for people age 65 and older.
 
There were 11 participating countries (Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, UK, US) representing a variety of health care approaches, including single-payer national systems and subsidized private insurance coverage. And their structures involved many different benefits, thresholds and exemptions.

Regardless, what each country shared aside from doing a better job for their seniors than the United States at a lower cost was that their systems covered all ages. Also, their seniors were less likely to arrive at age 65 trying to catch up after years without adequate medical care, and deductibles and cost-sharing requirements still left many Americans scrambling to afford drugs and doctors which also cost more.

Additionally, all 11 countries shared some problems: fragmented, uncoordinated care; gaps in hospital discharge plans; conflicting information from doctors, and a considerable proportion of older adults serving as caregivers to elderly or disabled people.

Survey Highlights (from NY Times article)

• The US leads in the proportion of people over age 65 who have two or more chronic diseases (68 percent), and who take four or more prescription drugs (53 percent).
• 19 percent of Americans say that cost was a barrier that prevented them from seeing a doctor, undergoing a recommended test or treatment or filling a prescription. The next highest nation was New Zealand at 10 percent.
• 21 percent of Americans had out-of-pocket medical expenses that topped $2,000, and 11 percent had problems paying their medical bills. In Norway and Sweden, 1 percent had problems paying; in Germany, 3 percent.
• 57 percent of Americans get same-day or next-day appointments when they are sick compared with more than 80 percent in France, Germany and New Zealand.
• Americans are near the top in emergency room use. They also rarely wait more than a month to see a specialist, possibly because there are more specialists.
• Americans are more likely to say their doctors spend enough time with them and encourage questions compared to other countries.
• The US ranks highest in having health care professionals who talk about healthy eating and exercise.
• Americans are more likely to say they are receiving good guidance in managing their chronic illnesses than compared with other countries.
• The US does better than almost everyone on advance care planning, and ranks second in having written plans describing end-of-life wishes.

Learn more:
https://newoldage.blogs.nytimes.com/2014/12/12/u-s-health-care-lags-worldwide-for-those-over-65/
http://seniorplanet.org/the-5-best-countries-to-grow-old-in
https://en.wikipedia.org/wiki/Universal_health_coverage_by_country