The Commonwealth Fund 1999
International Health Policy Survey of
the Elderly in Five Nations
Accompanies May/June 2000
Health Affairs article
Charts Originally Presented at the 1999 International
Symposium on Health Care Policy
Experiences with Health Care:
Access and Quality
3
Access to Needed Medical Care
Percent of the elderly who felt it was “extremely,” “very,” or
“somewhat” difficult to get needed medical care
20%
15%
13%
12%
9%
10%
6%
0%
Australia
Canada
New
United
United
Zealand
Kingdom
States
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
Percent of the Elderly with No
Doctor’s Visit in the Past Year
4
20%
16%
13%
10%
9%
10%
2%
0%
Australia
Canada
New
United
United
Zealand
Kingdom
States
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
5
Access to Specialists
Percent of the elderly who felt it was “extremely,” “very,” or
“somewhat” difficult to see a specialist when needed
30%
23%
15%
23%
14%
13%
10%
0%
Australia
Canada
New
United
United
Zealand
Kingdom
States
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
Long Waits for Nonemergency
Surgery
6
Percent of the elderly who needed nonemergency surgery and
waited five weeks or more
60%
51%
40%
34%
30%
19%
7%
0%
Australia
Canada
New
United
United
Zealand
Kingdom
States
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
Long Waits for Surgery Can Be a
Serious Problem
7
Percent of the elderly who needed non-emergency surgery and
said waiting a long time was a serious problem
20%
16%
13%
11%
10%
9%
4%
0%
Australia
Canada
New
Zealand
The Commonwealth Fund 1999 International Health Policy Survey
United
Kingdom
United
States
Elderly Adults
8
Quality of Care Ratings
Percent of the elderly who rated the medical care they received
in the past year as “excellent”
50%
39%
36%
32%
27%
25%
25%
0%
Australia
Canada
New
United
United
Zealand
Kingdom
States
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
Quality of Care at Doctor’s Visits
9
Percent of the elderly who rated the care received at their
most recent doctor’s visit as “excellent”
60%
51%
44%
40%
38%
31%
30%
0%
Australia
Canada
New
United
United
Zealand
Kingdom
States
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
10
Percent Hospitalized
Percent of the elderly hospitalized in the past year
40%
29%
29%
22%
28%
21%
20%
0%
Australia
Canada
New
United
United
Zealand
Kingdom
States
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
Quality of Care at the Hospital
11
Percent of the elderly who were hospitalized in the past two
years
and rated their overall hospital experience as “excellent”
50%
39%
31%
30%
25%
25%
27%
0%
Australia
Canada
New
United
United
Zealand
Kingdom
States
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
Availability of Nurses at the
Hospital
12
Percent of the elderly who were hospitalized in the past two
years
and rated the availability of nurses at the hospital as “excellent”
50%
44%
35%
34%
29%
21%
25%
0%
Australia
Canada
New
United
United
Zealand
Kingdom
States
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
Influence of the Elderly on Their Care
During Hospitalization
13
Percent of the elderly who were hospitalized in the past two years
and said they did not have enough input or say about their
treatment during hospitalization
30%
22%
22%
18%
17%
16%
15%
0%
Australia
Canada
New
Zealand
The Commonwealth Fund 1999 International Health Policy Survey
United
Kingdom
United
States
Elderly Adults
14
Length of Hospital Stay
Percent of the elderly who were hospitalized in the past two
years
and said their hospital stay was too short
20%
13%
10%
10%
9%
9%
9%
New
United
United
Zealand
Kingdom
States
0%
Australia
Canada
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
Receipt of Extra Help After
Hospitalization
15
Percent of the elderly who were hospitalized in the past two years
said they did not receive the help they needed when they arrived
home from the hospital
20%
14%
10%
10%
11%
4%
3%
0%
Australia
Canada
New
Zealand
The Commonwealth Fund 1999 International Health Policy Survey
United
Kingdom
United
States
Elderly Adults
Prescription Drugs
Reliance on Prescription
Medications
17
Percent of the elderly who have a medical condition that requires
them to take a prescription medication on a regular basis
100%
78%
72%
72%
70%
Canada
New
Zealand
United
Kingdom
77%
50%
0%
Australia
The Commonwealth Fund 1999 International Health Policy Survey
United
States
Elderly Adults
Lack of Coverage for Prescription
Medication
18
Percent of the elderly who say they have no public or private
coverage for the cost of prescription medications
40%
32%
20%
16%
8%
10%
1%
0%
Australia
Canada
New
United
United
Zealand
Kingdom
States
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
Out-of-Pocket Spending on
Prescription Medicines
19
Per month out-of-pocket expenditures for prescription medicine
by the elderly
100%
92%
50%
24%
10%
16%
20%
16%
0%
0%
AUS CAN NZ UK US
4% 2%
0%
AUS CAN NZ UK US
Nothing
The Commonwealth Fund 1999 International Health Policy Survey
More than $100
Elderly Adults
Home Health Care
21
Perceived Health Status
Percent of the elderly who rated their health as “fair” or “poor”
30%
26%
21%
23%
21%
18%
15%
0%
Australia
Canada
New
United
United
Zealand
Kingdom
States
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
Disabilities and Health Conditions
22
Percent of the elderly who have a disability or health condition
limiting full participation in daily activities
40%
26%
28%
31%
30%
29%
New
United
United
Zealand
Kingdom
States
20%
0%
Australia
Canada
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
Need for Assistance with Activities
of Daily Living
23
Percent of the elderly who needed home health or personal care
services to help with eating, dressing, bathing, or other needs in
the past two years
20%
14%
10%
16%
12%
10%
9%
0%
Australia
Canada
New
United
United
Zealand
Kingdom
States
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
Caregiving Experience of the
Elderly
24
Percent of the elderly who are currently caring or have in the
past two years cared for someone who is frail, sick, or disabled
30%
25%
27%
25%
21%
19%
15%
0%
Australia
Canada
New
Zealand
The Commonwealth Fund 1999 International Health Policy Survey
United
Kingdom
United
States
Elderly Adults
Caregivers’ Unmet Need for
Assistance
25
Percent of elderly caregivers who needed home health care
assistance for the person they cared for in the past two years and
couldn’t get it
40%
20%
32%
15%
19%
20%
10%
0%
Australia
Canada
New
Zealand
The Commonwealth Fund 1999 International Health Policy Survey
United
Kingdom
United
States
Elderly Adults
Caregivers’ Ability to Get Additional
Help
26
Percent of elderly caregivers reporting they used paid home
health care in addition to informal care
70%
53%
44%
58%
48%
46%
New
United
United
Zealand
Kingdom
States
35%
0%
Australia
Canada
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
The Elderly’s Ability to Get Additional
Help
27
Percent of the elderly in need of care in the home who received
some paid home health care
100%
67%
72%
83%
78%
63%
50%
0%
Australia
Canada
New
United
United
Zealand
Kingdom
States
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
Public or Government Program
Assistance with Paid Home Health
Care
28
Percent of elderly caregivers reporting paid home care
assistance who said a government program or public insurance
(rather than family) paid for care
100%
80%
80%
71%
67%
62%
50%
0%
Australia
Canada
New
Zealand
The Commonwealth Fund 1999 International Health Policy Survey
United
Kingdom
United
States
Elderly Adults
Many Elderly Receive Health
Assistance from Their Children
29
Percent of the elderly with children who “often” receive help from
them when they are ill
37%
40%
31%
30%
26%
32%
20%
0%
Australia
Canada
New
United
United
Zealand
Kingdom
States
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
The Elderly Receive Financial
Assistance from Their Children
30
Percent of the elderly with children who “often” or “sometimes”
receive financial support from their children
20%
18%
12%
12%
Australia
Canada
14%
13%
10%
0%
New
Zealand
The Commonwealth Fund 1999 International Health Policy Survey
United
Kingdom
United
States
Elderly Adults
Children Are a Major Source of
Assistance and Caregiving for Their
Parents
31
Percent of the elderly with children who said there was a time
they needed help from their children and didn’t get it
20%
10%
5%
7%
6%
6%
New
Zealand
United
Kingdom
7%
0%
Australia
Canada
The Commonwealth Fund 1999 International Health Policy Survey
United
States
Elderly Adults
Concerns About Costs and
Future Health Care Needs
Difficulties Meeting Regular
Expenses
33
Percent of the elderly who say it is “extremely” or
“somewhat” difficult to meet regular expenses
30%
26%
26%
21%
20%
15%
15%
0%
Australia
Canada
New
United
United
Zealand
Kingdom
States
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
Difficulties Paying Medical Bills
34
Percent of the elderly who had problems paying medical bills in
the past year
20%
10%
4%
6%
5%
3%
1%
0%
Australia
Canada
New
United
United
Zealand
Kingdom
States
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
Difficulties Affording Prescription
Medications
35
Percent of the elderly who did not fill a prescription for
financial reasons
20%
10%
7%
4%
2%
1%
3%
0%
Australia
Canada
New
United
United
Zealand
Kingdom
States
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
Concerns About the Impact of
Health Problems
36
Percent of the elderly who are “very concerned” they will have to
leave the place they are living now because of health problems
30%
19%
15%
13%
16%
11%
10%
0%
Australia
Canada
New
Zealand
The Commonwealth Fund 1999 International Health Policy Survey
United
Kingdom
United
States
Elderly Adults
Concerns About Becoming a
Burden on Family
37
Percent of the elderly who are “very concerned” they will
become a burden on their family
30%
25%
19%
15%
13%
13%
Australia
Canada
13%
0%
New
Zealand
The Commonwealth Fund 1999 International Health Policy Survey
United
Kingdom
United
States
Elderly Adults
Concerns About the Cost of
Long-Term Care
38
Percent of the elderly who are “very concerned” they will not
have enough money or insurance to pay for the long-term care
services they will need
30%
24%
22%
15%
12%
14%
12%
0%
Australia
Canada
New
Zealand
The Commonwealth Fund 1999 International Health Policy Survey
United
Kingdom
United
States
Elderly Adults
Concerns About Paying for Needed
Care
39
Percent of the elderly who are “very concerned” they will
not be able to pay for the medical care they need
30%
25%
21%
15%
14%
11%
10%
0%
Australia
Canada
New
United
United
Zealand
Kingdom
States
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
Disadvantaged Groups:
The Poor Elderly
Difficulty Meeting Regular
Expenses
41
Percent of the elderly with difficulty meeting regular expenses
Below Average Income
At or Above Average Income
50%
38%
32%
31%
25%
24%
23%
15%
9%
5%
9%
6%
0%
Australia
Canada
New
United
United
Zealand
Kingdom
States
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
42
Ability to Afford Health Care
Percent of the elderly who had problems paying their medical
bills
in the past year
20%
Below Average Income
10%
10%
6%
5%
0%
At or Above Average Income
0%
Australia
5%
3%
0%
Canada
2%
1%
2%
New
United
United
Zealand
Kingdom
States
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
43
Perceived Quality of Care
Percent of the elderly who rated the medical care they received
in the past year as “excellent”
Below Average Income
50%
At or Above Average Income
44%
43%
35%
35%
37%
23%
21%
25%
37%
28%
30%
0%
Australia
Canada
New
United
United
Zealand
Kingdom
States
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
Ratings of Hospital Experience
44
Percent of the elderly who had been hospitalized in the past two
years and rated the overall experience as “excellent”
Below Average Income
At or Above Average Income
50%
37% 39%
37%
29%
27%
32%
35%
29%
21%
25%
21%
0%
Australia
Canada
New
United
United
Zealand
Kingdom
States
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
Ability to Afford Prescription
Medications
45
Percent of the elderly who could not afford to fill a prescription
in the past year
20%
Below Average Income
At or Above Average Income
10%
10%
5%
1% <1%
<1%
2%
1%
2% 2%
1%
0%
Australia
Canada
New
United
United
Zealand
Kingdom
States
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
Receipt of Home Health Services
46
Percent of the elderly who have needed and received home
health services
Below Average Income
At or Above Average Income
100%
90%
90%
80%
78%
73%
64% 65% 64%
63%
50%
44%
0%
Australia
Canada
New
United
United
Zealand
Kingdom
States
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
Caregivers Who Receive Additional
Help
47
Percent of elderly caregivers whose care recipient
received paid home health care
Below Average Income
70%
61%
58%
42%
48%
At or Above Average Income
44%
45%
64%
59%
51%
37%
35%
0%
Australia
Canada
New
United
United
Zealand
Kingdom
States
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
Concern About the Affordability
of Long-Term Care
48
Percent of the elderly who are “very concerned” that they will
need long-term care and will be unable to pay for it
40%
Below Average Income
At or Above Average Income
33%
27%
20%
20%
15%
14%
6%
7%
12%
10%
8%
0%
Australia
Canada
New
United
United
Zealand
Kingdom
States
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
Concern About Being Unable to Pay
for Needed Care
49
Percent of the elderly who are “very concerned” that they will
have large medical expenses and will be unable to pay for needed
care
Below Average Income
At or Above Average Income
40%
28%
20%
19%
12%
9%
28%
15%
7%
11%
9%
10%
0%
Australia
Canada
New
United
United
Zealand
Kingdom
States
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
Views of the System
The Elderly’s View of Their
Health Care System
51
New
United United
Australia Canada
Zealand Kingdom States
System works wellonly minor changes
needed
Some good things but
fundamental change is
needed
System has so much
wrong it needs
complete rebuilding
34%
38%
22%
39%
25%
38%
40%
45%
44%
44%
24%
18%
31%
15%
26%
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
Percent of the Elderly Population
Saying Their Health Care System
Needs to Be Completely Rebuilt
52
50%
41%
39%
25%
24%
1998
31%
27%
1999
27% 26%
18%
12%
15%
0%
Australia
Canada
New
United
United
Zealand
Kingdom
States
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
Perceptions of Recent Changes in the
Quality of Medical Care for the Elderly
53
Percent of the elderly saying that medical care for the
elderly is better/worse compared with five years ago
60%
48%
29%
24%
30%
14% 12%
36%
21%
15%
26%
8%
0%
AUS CAN NZ
UK
US
AUS CAN NZ
Better
The Commonwealth Fund 1999 International Health Policy Survey
UK
US
Worse
Elderly Adults
Comparisons of Care
Experiences for the Under and
Over Age 65 Populations in
Five Nations
55
Difficulty Getting Needed Care
Percent who felt it was “extremely,” “very,” or “somewhat”
difficult to get needed medical care
Under Age 65
40%
Age 65 and Over
30%
21%
20%
16%
15%
19%
17%
15%
12%
7%
7%
0%
Australia
Canada
New
United
United
Zealand*
Kingdom
States
* The age break in New Zealand is “under age 70” and “age 70 and over.”
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
Worries About Not Being Able to
Afford Needed Care
56
Percent who are “very worried” that if they become seriously ill,
they will not be able to get the medical care they need because
they cannot afford it
Under Age 65
Age 65 and Over
60%
44%
30%
26%
18%
23%
30%
17%
25%
15%
9%
8%
New
United
United
Zealand*
Kingdom
States
0%
Australia
Canada
* The age break in New Zealand is “under age 70” and “age 70 and over.”
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
Views of the Health Care System
57
Percent who think their health care system has so much wrong
with it that it needs to be completely rebuilt
60%
Under Age 65
Age 65 and Over
41%
39%
30%
29%
22%
27%
34%
31%
27%
14% 12%
0%
Australia
Canada
New
United
United
Zealand*
Kingdom
States
* The age break in New Zealand is “under age 70” and “age 70 and over.”
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults
58
Methodology
The Commonwealth Fund 1999 International Health Policy
Survey of the Elderly consisted of telephone interviews
with 3,515 with adults age 65 or older regarding their
health care experiences and related concerns in five
countries: Australia, Canada, New Zealand, the United
Kingdom and the United States. Sample sizes in each
country were 701, 700, 700, 714 and 700 respectively.
The survey was commissioned by The Commonwealth
Fund and conducted by Harris Interactive, Inc. and their
international affiliates from April to June 1999.
Researchers from the Harvard School of Public Health,
Harris Interactive and the Commonwealth Fund
collaborated in the design of the common survey
instrument that was administered in all countries.
Several measures were taken or adapted from prior
instruments developed for prior international health
surveys. Instruments were reviewed by health care
experts in all nations and presented in each nation. The
average length of survey administration was 12 minutes
in each of the five nations.
The Commonwealth Fund 1999 International Health Policy Survey
Elderly Adults