Mystery Ills: Are Older Americans Sicker Than Those In Other Countries?

Americans over 65 are apparently sicker than their counterparts in 10 other developed countries, according to a new international comparison.

But this raises a big question. Are American elders really sicker than those in other rich nations? Or are their illnesses just more likely to be diagnosed (or over-diagnosed) than elsewhere?

The mystery is deepened by another fact: As a group, the rising demographic of Americans over 65 are younger on average than elderly populations in the other 10 countries. But they’re three times more likely to have two or more chronic conditions than those in the United Kingdom.

Also, American elders are 21 percent more likely to have multiple chronic diseases than those just across the border in Canada, and 40 percent more likely than Germans.

What gives?

“Fourteen percent of the U.S. population is over 65, versus 21 percent of the German population,” study author Donald Moulds says. “This is really quite a difference, So the fact that we have a younger population with more chronic conditions is particularly alarming.”

Alarming, he says, because of what it means for the future of Medicare, the federal program that pays medical bills for the elderly and disabled, as the U.S. population continues to age. Already, nearly half of Medicare’s $300 billion-plus budget is spent on the 14 percent of beneficiaries with six or more chronic conditions.

The new numbers come from a survey of nearly 16,000 over-65 citizens in 11 nations conducted by the Commonwealth Fund and published online Thursday by the journal Health Affairs. Other than the U.S., the U.K., Canada and Germany the countries studied are Australia, France, the Netherlands, Sweden, Norway, Switzerland and New Zealand.

Moulds says the study can’t answer why American elders report more chronic illness than those in other peer nations. Partly it may be due to the spotty access to medical care that many Americans have had before they turned 65 — and before the Affordable Care Act began to expand coverage.

“If you think about chronic conditions like diabetes and heart disease, these aren’t conditions that people wake up when they’re 65 and suddenly get them,” says Moulds, who is executive vice president of the New York-based Commonwealth Fund. “They develop over a lifetime.”

There’s another way older American are worse off than their counterparts in developed countries. They spend a lot more out of their own pockets on medical care, despite having Medicare.

One reason: American elders are the most medicated among those in the 11 countries. More than half are taking four or more prescription drugs. In Switzerland and France, only 29 percent are.

About one in five U.S. elders spends $2,000 or more out-of-pocket for care. The same proportion say cost deters them from care — from going to a doctor when they have a medical problem, from getting a recommended medical test or treatment, or from filling a prescription or taking medication as prescribed.

That’s twice the proportion of seniors in most of the other countries who spent that much out-of-pocket or say that cost is a barrier to seeking care.

And even though the United States spends far more on health care than the other 10 countries — often twice as much per person — American elders don’t have equal access to care. Fifty-seven percent say they can get a same-day or next-day appointment for care when they’re sick, compared to 83 percent in France and New Zealand, 81 percent in Germany and 65 percent in the U.K.

Only Canadians have worse access to routine care — 45 percent say they can get timely appointments.

When they do get seen, American elders are most likely to report that their care is poorly coordinated. Almost one in four say their medical records or test results were not available or tests had to be redone. They’re most likely to say they’ve gotten conflicting information from different doctors.

But there are some ways in which the U.S. system does better. American elders have the best access to specialists. Their doctors were among the most likely to counsel them about diet and exercise.

And the U.S. system is ahead of others when it comes to end-of-life care. More than three-quarters of older Americans say they’ve talked with their caregivers about the kind of treatment they want if they can no longer make decisions for themselves. And two-thirds have appointed a health-care proxy — someone authorized to make treatment decisions when they cannot.