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