In the U.S., having health insurance is necessary, but not sufficient to ensure access to affordable medical care.
While the U.S. lacks a universal health care system like those that exist in most other wealthy nations, most Americans over 65 are insured through Medicare. Yet many still struggle to afford care, with high out-of-pocket costs putting necessary medications and doctor visits out of reach, according to research from The Commonwealth Fund, a nonprofit that works to promote an equitable health care system.
These extra costs, for which Medicare beneficiaries are on the hook, make it harder for older Americans to access affordable care relative to their peers in nine other countries, the group found. Researchers compared coverage for older adults in the U.S. to health care systems in Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland and the United Kingdom.
Nearly one in four older adults in the U.S. spent at least $2,000 in out-of-pocket expenses last year, compared to less than 5% of older adults in France and the Netherlands who spent that much, The Commonwealth Fund found. Only in Switzerland did older adults report spending more on health care than those in the U.S.
“The reason to focus on this population is because in the U.S. nearly every adult over 65 has Medicare,” Munira Z. Gunja, senior researcher for international health policy and practice innovations at The Commonwealth Fund told CBS MoneyWatch. While the U.S. stands out 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,” she said.
Does Medicare fall short?
But the study suggests that the kind of coverage Medicare plans provide isn’t meeting many Americans’ needs. Eight percent of older adults in the U.S., more than any other wealthy country except Austria, reported delaying or forgoing medical care because of costs. And there are repercussions to not getting the care one needs: One-third of older U.S. adults who said they faced cost-related barriers to accessing care reported being either in fair or poor health.
“We find that while nearly every older adult has Medicare coverage, it is still more expensive than what older adults in other nations face, and because of that, older adults in the U.S. are more likely to skip care,” Gunja said. “When they need prescription drugs, they are more likely to skip getting those too.”
Oftentimes, for example, Medicare Advantage members find themselves seeing out-of-network doctors, which exposes them to “a ton of health care costs,” according to Gunja.
One exception
There’s one area in which Medicare beneficiaries faced few out-of-pocket costs and, as a result, were less likely to skip care — mental health treatment. Less than 5% of residents in all nations skipped mental health care over affordability concerns. The stat illustrates that when treatment is affordable, patients are more inclined to seek out the care they need, according to Gunja.
“It’s a benefit that’s offered on all health plans, and we see what happens when people don’t need to spend as much on a service,” she said.
Solutions?
When older people skip or delay care, their health can worsen, leading to sicker patients, who tend to require more costly care. That in turn drives up federal Medicare spending, according to The Commonwealth Fund.
Gunja suggests that the U.S. can look to other countries for solutions that make health care more affordable for older adults. Some examples include capping out-of-pocket expenses and fully covering hospital and physician services.
“Across the board, the U.S. generally comes out last for most measures when it comes to affordability measures,” Gunja said. “Getting health insurance is absolutely necessary. But it’s only the first step. We need to make sure coverage is not just comprehensive, but also affordable.”