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