In the United States, having health insurance is required, yet it is insufficient to provide access to affordable medical treatment.
While the United States does not have a national health-care system like most other developed countries, Medicare covers the majority of Americans over the age of 65. However, many people continue to struggle to afford care, with high out-of-pocket expenses making vital drugs and doctor appointments unaffordable, according to research from The Commonwealth Fund, a charity that seeks to create an equitable health-care system.
The organization discovered that these additional expenditures, which Medicare beneficiaries bear, make it more difficult for older Americans to receive inexpensive care than their counterparts in nine other nations. Researchers compared older individuals’ coverage in the United States to health-care systems in Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, and the United Kingdom.
According to The Commonwealth Fund, nearly one in every four older persons in the United States spent at least $2,000 in out-of-pocket spending last year, while less than 5% of older adults in France and the Netherlands did the same. Only in Switzerland did older persons report spending more on healthcare than in the United States.
“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 United States is “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 noted.
Does Medicare fall short?
However, the analysis reveals that the coverage provided by Medicare programs does not satisfy the needs of many Americans. Eight percent of older persons in the United States, more than any other wealthy country except Austria, reported delaying or skipping medical care due to expense. And there are consequences to not getting the care you need: One-third of older persons in the United States who indicated they had difficulty receiving care due to cost reported being in fair to 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,” according to Gunja. “When they need prescription drugs, they are more likely to skip getting those too.”
Medicare Advantage users, for example, frequently see out-of-network providers, exposing them to “a ton of health care costs,” according to Gunja.
One exception
There was one area where Medicare patients had few out-of-pocket expenses and hence were less inclined to miss care: mental health treatment. Less than 5% of inhabitants in all countries skipped mental health care due to cost concerns. According to Gunja, the statistics show that when therapy is accessible, patients are more likely to seek the care they require.
“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 told me.
Solutions?
When elderly adults skip or delay care, their health can deteriorate, resulting in sicker patients who require more expensive treatment. According to the Commonwealth Fund, this leads to an increase in federal Medicare spending.
Gunja says that the United States should look to other countries for methods to make health care more affordable for older persons. Some examples include limiting out-of-pocket payments and covering all hospital and physician treatments.
“Across the board, the U.S. generally comes out last for most measures when it comes to affordability measures,” according to Gunja. “Health insurance is definitely required. But this is merely the first step. We need to ensure that coverage is both comprehensive and cheap.”
