The Commonwealth Fund 1999 International Health Policy Survey of the Elderly in Five Nations Accompanies May/June 2000 Health Affairs article Charts Originally.

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


4

Percent of the Elderly with No Doctor’s Visit in the Past Year

2%

9%

16%

13%

10%

0%

10%

20%


Zealand

United

K ingdom

United

States


5

Access to Specialists

10%

23%

13%

23%

14%

0%

15%

30%


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


6

Long Waits for Nonemergency Surgery

19%

40%34%

51%

7%

0%

30%

60%


Zealand

United

K ingdom

United

States

Percent of the elderly who needed nonemergency surgery and waited five weeks or more


7

Long Waits for Surgery Can Be a Serious Problem

9%11%

16%

13%

4%

0%

10%

20%


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


8

Quality of Care Ratings

36%

27%

39%

25%

32%

0%

25%

50%


Zealand

United

K ingdom

United

States

Percent of the elderly who rated the medical care they received in the past year as “excellent”


9

Quality of Care at Doctor’s Visits

44%38%

51%

31%

40%

0%

30%

60%


Zealand

United

K ingdom

United

States

Percent of the elderly who rated the care received at their most recent doctor’s visit as “excellent”


10

Percent Hospitalized

29%

22%

29%

21%

28%

0%

20%

40%


Zealand

United

K ingdom

United

States

Percent of the elderly hospitalized in the past year


11

Quality of Care at the Hospital

30%25%

39%

31%27%

0%

25%

50%


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”


12

Availability of Nurses at the Hospital

35%

21%

44%

29%34%

0%

25%

50%


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”


13

Influence of the Elderly on Their Care During Hospitalization

16%

22%

18%

22%

17%

0%

15%

30%


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


14

Length of Hospital Stay

9%

13%

10%9% 9%

0%

10%

20%


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


15

Receipt of Extra Help After Hospitalization

4%

14%

11%10%

3%

0%

10%

20%


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


17

Reliance on Prescription Medications

78%72% 72% 70%

77%

0%

50%

100%


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


18

Lack of Coverage for Prescription Medication

32%

1%

16%

10%8%

0%

20%

40%


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


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


21

Perceived Health Status

21% 21%18%

26%23%

0%

15%

30%


Zealand

United

K ingdom

United

States

Percent of the elderly who rated their health as “fair” or “poor”


22

Disabilities and Health Conditions

26%28%

31% 30% 29%

0%

20%

40%


Zealand

United

K ingdom

United

States

Percent of the elderly who have a disability or health condition limiting full participation in daily activities


23

Need for Assistance with Activities of Daily Living

10%

14%16%

12%

9%

0%

10%

20%


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


24

Caregiving Experience of the Elderly

21%

25% 25%

19%

27%

0%

15%

30%


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


25Caregivers’ Unmet Need for Assistance

10%

32%

20%19%15%

0%

20%

40%


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


26Caregivers’ Ability to Get Additional Help

44%

53%48% 46%

58%

0%

35%

70%


Zealand

United

K ingdom

United

States

Percent of elderly caregivers reporting they used paid home health care in addition to informal care


27The Elderly’s Ability to Get Additional Help

67%72%

78%

63%

83%

0%

50%

100%


Zealand

United

K ingdom

United

States

Percent of the elderly in need of care in the home who received some paid home health care


28

Public or Government Program Assistance with Paid Home Health Care

80%

67%

80%71%

62%

0%

50%

100%


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


29

Many Elderly Receive Health Assistance from Their Children

31%

26%

37%

30%32%

0%

20%

40%


Zealand

United

K ingdom

United

States

Percent of the elderly with children who “often” receive help from them when they are ill


30

The Elderly Receive Financial Assistance from Their Children

12% 12%14%

18%

13%

0%

10%

20%


Zealand

United

K ingdom

United

States

Percent of the elderly with children who “often” or “sometimes” receive financial support from their children


31

Children Are a Major Source of Assistance and Caregiving for Their Parents

5%7%

6% 6%7%

0%

10%

20%


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


33

Difficulties Meeting Regular Expenses

20%

15%

26% 26%

21%

0%

15%

30%


Zealand

United

K ingdom

United

States

Percent of the elderly who say it is “extremely” or “somewhat” difficult to meet regular expenses


34

Difficulties Paying Medical Bills

4%3%

5%

1%

6%

0%

10%

20%


Zealand

United

K ingdom

United

States

Percent of the elderly who had problems paying medical bills in the past year


35

Difficulties Affording Prescription Medications

1%

4%2%

3%

7%

0%

10%

20%


Zealand

United

K ingdom

United

States

Percent of the elderly who did not fill a prescription for financial reasons


36

Concerns About the Impact of Health Problems

10%13%

19%

11%

16%

0%

15%

30%


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


37

Concerns About Becoming a Burden on Family

13% 13%

25%

13%

19%

0%

15%

30%


Zealand

United

K ingdom

United

States

Percent of the elderly who are “very concerned” they will become a burden on their family


38

Concerns About the Cost of Long-Term Care

12%14%

24%

12%

22%

0%

15%

30%


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


39

Concerns About Paying for Needed Care

11%14%

25%

10%

21%

0%

15%

30%


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


41

Difficulty Meeting Regular Expenses

24% 23%

31%

38%

32%

9%6%5%

9%

15%

0%

25%

50%


Zealand

United

K ingdom

United

States

Below Average IncomeAt or Above Average Income

Percent of the elderly with difficulty meeting regular expenses


42

Ability to Afford Health Care

5%6%

5%

2%

10%

2%1%

3%

0%0%0%

10%

20%


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


43

Perceived Quality of Care

43%

35%

44%

28%

37%

30%

23%

37%

21%

35%

0%

25%

50%


Zealand

United

K ingdom

United

States


Percent of the elderly who rated the medical care they received in the past year as “excellent”


44

Ratings of Hospital Experience

37%

29%35%

21%

32%37%

21%27% 29%

39%

0%

25%

50%


Zealand

United

K ingdom

United

States


Percent of the elderly who had been hospitalized in the past two years and rated the overall experience as “excellent”


45

Ability to Afford Prescription Medications

5%

2% 2%

10%

1% 1%2%

1%<1%<1%

0%

10%

20%


Zealand

United

K ingdom

United

States


Percent of the elderly who could not afford to fill a prescription in the past year


46

Receipt of Home Health Services

73%78%

90%80%

65%63%

90%

64%64%

44%

0%

50%

100%


Zealand

United

K ingdom

United

States


Percent of the elderly who have needed and received home health services


47Caregivers Who Receive Additional Help

58%

48%

61% 59%64%

51%

37%45%42% 44%

0%

35%

70%


Zealand

United

K ingdom

United

States


Percent of elderly caregivers whose care recipient received paid home health care


48

Concern About the Affordability of Long-Term Care

14%

20%

27%

33%

6% 7% 8%12%

10%

15%

0%

20%

40%


Zealand

United

K ingdom

United

States


Percent of the elderly who are “very concerned” that they will need long-term care and will be unable to pay for it


49

Concern About Being Unable to Pay for Needed Care

12%

19%

28% 28%

9%7%

11% 10%9%

15%

0%

20%

40%


Zealand

United

K ingdom

United

States


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


51

The Elderly’s View of Their Health Care System


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%


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%


Zealand

United

K ingdom

United

States

1998 1999


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


55

Difficulty Getting Needed Care

30%

17%19%

21%

16% 15%

7%

12%15%

7%

0%

20%

40%


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


56

Worries About Not Being Able to Afford Needed Care

25%

15%

44%

23%26%

8%9%

30%

17%18%

0%

30%

60%


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



57

Views of the Health Care System

34%

14%

31%

22%

29% 27%

12%

41%

27%

39%

0%

30%

60%


Zealand*

United

K ingdom

United

States

Under Age 65 Age 65 and Over


Percent who think their health care system has so much wrong with it that it needs to be completely rebuilt


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.

The Commonwealth Fund 1999 International Health Policy Survey of the Elderly in Five Nations Accompanies May/June 2000 Health Affairs article Charts Originally.

Documents

health care policy slide

commonwealth fund

elderly percent

home health care slide

health conditions percent

hospital slide

percent hospitalized

quality slide