In the United States, having health insurance is necessary but not sufficient to guarantee access to affordable health care services.
Although the United States does not have the same universal health care system that exists in most other wealthy countries, most Americans age 65 and older have insurance through Medicare. However, research by the Commonwealth Fund, a nonprofit organization working to promote an equitable healthcare system, shows that many people still struggle to pay their medical bills, with high out-of-pocket costs preventing them from getting the medication or doctor’s visits they need. He says he can’t reach it.
As Medicare beneficiaries struggle with these additional costs, older Americans have a harder time accessing affordable care than their peers in nine other countries, the group found. . Researchers compared coverage for seniors in the United States with health systems in Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, and the United Kingdom.
Nearly one in four seniors in the United States spent at least $2,000 out of pocket last year, while less than 5% of seniors in France and the Netherlands spent the same amount. , a Commonwealth Fund study found. Only Switzerland reported that older adults spend more on health care than in the United States.
“The reason we focus on this population is because in the United States, nearly all adults over age 65 are enrolled in Medicare,” said Munira Z. Ganja, senior fellow in global health policy and practice innovation at the Commonwealth Fund. told CBS MoneyWatch. Although the United States stands out as “the only high-income country without universal health care,” it is “at least on par with other countries” when it comes to people over 65, he said.
Is Medicare in short supply?
However, this study suggests that the type of coverage provided by Medicare plans does not meet the needs of many Americans. Eight percent of older Americans report delaying or forgoing medical care because of cost, more than any other wealthy country except Austria. And then there are the consequences of not getting the care they need. One-third of older Americans who say they face cost barriers to receiving care report fair or poor health.
“We found that although nearly all seniors have Medicare coverage, premiums are still higher than those faced by seniors in other countries, so older Americans are more likely to skip medical care.” ” said Gunja. “Even if you need a prescription drug, you are more likely not to get it.”
For example, Medicare Advantage members often see out-of-network doctors, exposing them to “significant medical costs,” Ganja said.
one exception
There was one area where Medicare beneficiaries had little out-of-pocket costs and were therefore less likely to skip care. It’s mental health treatment. Across all countries, fewer than 5% of residents skipped mental health care due to affordability concerns. Ganja said the statistics show that patients are more likely to seek the care they need when treatment is affordable.
“This is a benefit that all health plans offer, and we’re seeing what happens when people don’t have to spend as much on services,” she said.
What is the solution?
When older adults skip or delay treatment, their health status deteriorates and can lead to more severe illness in patients who require more expensive treatment. That would boost federal Medicare spending, according to the Commonwealth Fund.
Gunja suggests the United States could look to other countries for solutions to make health care more affordable for seniors. Examples include maximum out-of-pocket costs and full coverage of hospital and physician services.
“Overall, when it comes to affordability policies, the United States is generally at the bottom of most policies,” Gunja said. “Having health insurance is absolutely necessary, but it’s only the first step. We need to make sure that coverage is not only comprehensive, but also affordable. ”
