U.S. not most effective country in providing healthcare to people 50 years and older

Nov. 5, 2020

An international study led by UCLA Fielding School of Public Health researchers has determined that the United States is far from the most effective healthcare provider for those 50 and older among 23 countries, ranging from Austria to the United States, according to a press release from the University of California at Los Angeles (UCLA).

In terms of best practices, such as an annual doctor's check-up, the United States came in at 7th place, with almost 8.5 percent of the over-50 population not seeing a doctor in 2016, the year that was surveyed. By contrast, a significantly higher percentage of older people in the Czech Republic, Belgium, France, Germany, Luxembourg, and Portugal than Americans got to see a doctor, with the shortfall ranging from roughly 5 percent in the Czech Republic to 7 percent in France.

"In the highest-performing health systems such as those of the richer countries of Western Europe, older adults almost all were able to consult a doctor, at least annually, without incurring high out of pocket expenses," said James Macinko, UCLA Fielding School of Public Health professor in the Departments of Community Health Sciences and Health Policy and Management. "That is not as common an outcome in the U.S."

The study was published in the November edition of the peer-reviewed journal Health Affairs and includes authors from universities in the United States and Brazil. The researchers' work examined some 100,000 older adults in one of the largest studies ever investigating cross-national differences in healthcare access, use, and related health expenditures among older adults, and one of only a handful that has investigated health system factors.

In addition to the United States, the countries surveyed included several with comparably high per capita incomes, including Luxembourg, Switzerland, Denmark, Sweden, Austria, Germany, and France, most of which have some variant of universal health coverage.

Not all the team's findings reflected poorly on the U.S. system, especially when it came to access to doctor visits. The access to care provided by the U.S. healthcare system comes with a price, however, researchers found. When it came to "catastrophic healthcare expenditures" (defined as when 25 percent or more of household income had to be spent out of pocket on healthcare), the United States ranked last in terms of high-income countries, although higher rates were observed in Eastern European and middle-income countries such as Brazil and Mexico.

The researchers found that after individual characteristics and health needs were controlled for, national rates varied up to tenfold for poor access (no doctor visit) and threefold for potential overutilization (15 or more doctor visits and multiple hospitalizations) in the past year.

In terms of hospitalization, the United States had the highest number of older patients hospitalized, with more than 9 percent hospitalized two or more times in the past year, as opposed to as few as 6.5 percent in Germany, 5.5 percent in France, roughly 5 percent in Sweden and Switzerland, and a little over 4 percent in Denmark. A significant proportion of these events are re-hospitalizations that occur due to poor quality or inadequate follow-up care.

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