In the United States, having health insurance is necessary but not sufficient to ensure access to affordable health care.
Although the United States lacks a universal health insurance system like most other wealthy countries, most Americans over the age of 65 are insured through Medicare. Yet even so, they still struggle to afford medical care, with high out-of-pocket costs putting necessary medications and doctor visits beyond the reach of many, according to new research from the Commonwealth Foundation, a nonprofit organization dedicated to promoting equitable health. system.
These additional costs incurred by Medicare beneficiaries make it more difficult for U.S. seniors to access affordable care compared with seniors in nine other countries. Researchers compared health care coverage for seniors in the United States with health care systems in Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland and the United Kingdom.
Case in point: Nearly a quarter of U.S. seniors paid at least $2,000 out of pocket last year, while less than 5 percent of seniors in France and the Netherlands paid that much out of pocket, research shows. Only Swiss seniors spend more on health care than American seniors.
“The reason for focusing on this population is that in the United States, almost every adult over the age of 65 has health insurance,” Munira Z. Gunja, senior fellow for international health policy and practice innovation at the Commonwealth Fund, told CBS MoneyWatch. While the United States is “the only high-income country without a universal health care system,” when it comes to people over 65, “at least we're on par with other countries,” she said.
Insufficient health insurance?
But research shows that Medicare plans don’t provide the coverage that many Americans need. More seniors (8%) in the United States delay or forgo health care because of cost than in any other wealthy country except Austria. Not getting the care you need has consequences: One in three older Americans say they face cost-related barriers to receiving care and their health is either fair or poor.
“We found that while nearly every senior has health insurance, it still faces higher costs than seniors in other countries, and therefore seniors in the United States are more likely to skip health insurance,” Gonja said. “When they need prescription medications, they are also more likely not to purchase those medications.”
For example, Medicare Advantage members often find themselves seeing doctors out-of-network, which exposes them to “substantial health care costs,” according to Gonja.
There is one exception
One area where Medicare beneficiaries have few out-of-pocket costs and therefore are less likely to skip care — mental health treatment. Across all countries, less than 5% of residents skip mental health care due to affordability issues, suggesting that patients are less willing to skip seeing a doctor when treatment is affordable.
“This is a benefit that all health plans offer, and we see what happens when people don't have to spend as much money on services,” Gonja said.
Solution?
When older adults skip or delay care, their conditions worsen, leaving patients sicker who often require more expensive care. This, in turn, increases Medicare spending, according to the Commonwealth Fund.
Gonja suggested the U.S. could look to other countries for solutions to make health care more affordable for seniors. Some examples include limiting out-of-pocket expenses and paying in full for hospital and physician services.
“Overall, when it comes to affordability measures, the U.S. typically ranks last on most measures,” Gonja said. “Access to health insurance is an absolute necessity. But it's just the first step. We need to make sure that coverage is not only Comprehensive and affordable.”
