In the US, having health insurance is necessary, but not sufficient to ensure access to affordable medical care.
While the US lacks a universal health care system like most other wealthy countries, most Americans over the age of 65 are insured through Medicare. Yet, many people still struggle to afford care, as high out-of-pocket costs put essential medications and doctor visits out of reach for many of them. Research From the Commonwealth Fund, a nonprofit that works to promote an equitable health care system.
The group found that these additional costs, which Medicare beneficiaries shoulder, make it harder for older Americans to access affordable care than their peers in nine other countries. Researchers compared coverage for older adults in the US with health care systems in Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland and the United Kingdom.
The Commonwealth Fund found that nearly one in four adults in the US spent at least $2,000 out of pocket last year, while less than 5% of older adults in France and the Netherlands spent that much. Only in Switzerland do older adults report spending more on health care than in the US
“The reason we focused on this population is that almost every adult over the age of 65 in the U.S. has Medicare,” Munira Z Gunja, senior researcher for international health policy and practice innovations at the Commonwealth Fund, told CBS MoneyWatch. While the US stands as “the only high-income country without a universal health system”, when it comes to the over-65 population, “at least, we are on par with other countries,” he said.
Does Medicare fall short?
But studies show that the level of coverage Medicare plans provide is not meeting the needs of many Americans. 8% more older adults in the US reported delaying or forgoing medical care because of cost, compared to any other rich country except Austria. And not getting the care one needs has consequences: One-third of older U.S. adults said they face cost-related barriers to getting care, regardless of whether they were in fair or poor health.
Gunza said, “We found that while almost every older adult has Medicare coverage, it is still more expensive than older adults in other countries, and because of this, older adults in the U.S. are more likely to forgo care. Is.” “When they need prescription drugs, they stop taking them, too.”
According to Gunja, for example, Medicare Advantage members often find themselves seeing out-of-network doctors, causing them to face “huge health care costs.”
an exception
There is one area in which Medicare beneficiaries face few out-of-pocket expenses and, as a result, are less likely to drop out of care – mental health treatment. Less than 5% of residents in all countries forgo mental health care due to affordability concerns, indicating that when treatment is cheaper, patients are reluctant to visit a doctor.
“It's a benefit that's offered on all health plans, and we see what happens when people don't have to spend as much on a service,” Gunza said.
Solution?
When older people skip care or delay care, their conditions worsen, leading to sicker patients who require more expensive care. According to the Commonwealth Fund, this increases federal Medicare spending.
Gunja suggests that the US could look to other countries for solutions that make health care more affordable for older adults. Some examples include setting limits on out-of-pocket expenses and fully covering hospital and physician services.
“When it comes to affordability measures, overall, the US generally ranks last on most measures,” Gunza said. “Getting health insurance is absolutely essential. But it's only the first step. We need to make sure coverage is not only comprehensive, but also affordable.”