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Sicker seniors: US lags on elder health vs. other nations

It turns out that the "Golden Years" aren't quite that golden—even when you have Medicare.

Elderly Americans are in worse health and have a tougher time dealing with medical costs than senior citizens in 10 other advanced industrialized nations, a new report Wednesday reveals.

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In fact, nearly 1 in 5 seniors skipped a doctor's visit, test or a prescribed medication because of the out-of-pocket cost, far more than any other country looked at in the Commonwealth Fund survey.

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Older Americans are also more likely than counterparts in most of those countries to have problems getting a same-day or next-day appointment with their doctor, and having to go to the ER instead when they get sick, according to the survey, which is detailed in an article being published by the journal Health Affairs on Wednesday.

On the bright side, senior citizens in the U.S. had better luck than those in other countries in how their chronic illnesses are managed, communications with doctors and transitioning from the hospital back to home. And, notably, 86 percent of older U.S. adults said they could get an appointment with a specialist within one month—significantly better than any other country in the survey besides Switzerland, which had an 82 percent success rate on that question.

But the worse outcomes for Americans age 65 or older come despite the fact that they are the one group in the U.S. that has near-universal health coverage, in the form of the Medicare insurance program administered by the federal government. The other countries surveyed by the Commonwealth Fund all have some form of universal health coverage.

"Previous surveys have shown that older people with Medicare coverage fare better than working-age adults in the U.S.," said Robin Osborn, vice president of the Commonwealth Fund's international health policy program.

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"The new survey shows that there are areas, such as managing patients who have chronic illnesses and hospital discharge planning, where the U.S. does well compared to other countries," Osborn said. "However, older Americans struggle more to get and afford the health care they need, indicating the need to improve Medicare's financial protections."

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In addition to U.S. residents, the Commonwealth Fund survey questioned seniors in 10 other countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom. More than 15,000 people were asked questions about their medical status, costs and issues accessing care.

Commonwealth Fund President David Blumenthal told reporters in advance of the report's release that he was unaware of any prior survey "that looked at this population" and compared their experiences to counterparts in different countries.

Despite the fact American seniors are younger, on average, than the senior populations of the other countries, "The U.S. has the highest rates of chronic conditions," Blumenthal said.

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The Health Affairs article about the report noted that 68 percent of American seniors "reported two or more conditions."

"In contrast, only one-third of older adults in the United Kingdom reported having multiple chronic conditions," the article said.

The U.S. also was the clear leader in the number of older people who avoided seeing a doctor or skipping treatments and drugs because of the costs associated with those things.

Nineteen percent of older Americans said they skipped such services or prescriptions because of those costs. In New Zealand, which had the second-highest result in that category, just 10 percent of seniors skipped those services or drugs because of costs.

In France, which had the lowest result in that category, just 3 percent of seniors skipped those things due to what they would have to pay for them.

On a related question, 21 percent of U.S. seniors said that they had out-of-pocket medical expenses of $2,000 or more in the past year. Only Switzerland had a higher rate, with 22 percent of seniors there reporting such costs.

The next highest country in that category was Australia, with 13 percent of respondents giving that answer.

American seniors also ended up going to the emergency room for treatment more than residents of most other countries other than Canada. Thirty-nine percent of older residents of both those countries had gone to the ER in the past two years.

The U.S., Canada, Norway and Sweden were also on the low end of countries with seniors being able to get a same-day or next-day appointment with a medical provider when they got sick: less than 60 percent of elderly people in those countries said they could do so.

On the other hand, the American seniors, and those in the United Kingdom, have markedly more success than those in other countries with discussing treatment goals with doctors, and with getting clear directions on when they should get further care.