An aging population isn’t just a challenge for providers and policymakers in the U.S. – it’s an issue most nations contend with. Experts participating in last week’s webinar from The Commonwealth Fund, Health and Health Care Among Older Adults in 11 Countries, confirm that finding the right balance between clinical and social services, cost-effectiveness and promoting aging in place is tricky, no matter what health system is in place.
The webinar featured key findings from The Commonwealth Fund’s latest International Health Policy Survey, which examined consumer opinions of health systems and care delivery. Experts from France, the United Kingdom and the U.S. provided perspective on the issues. This previous blog post summarizes survey results.
Health care in France was highly rated by survey respondents, said Isabelle Durand-Zaleski, M.D., Ph.D., professor of medicine, researcher in clinical public health at Hospital Henri Mondor. About 80 percent of France’s 65+ population has at least one chronic disease, but thanks to that country’s statutory health insurance, care and treatment is covered 100 percent. In France, care is universal and publicly-funded.
Additionally, “if an older person qualifies for help with daily living activities such as shopping or house cleaning, it is provided free of cost by community social services,” she said. Some older residents even receive a cash stipend to spend on services as they wish.
The French health system also has the best same-day access to care, low incidence of avoidable emergency department visits and short waiting times for primary care appointments. While statutory health funding means excellent access to physicians and health care, Durand-Zaleski said that her country must do a better job of care coordination and improve task shifting between health and social care.
“Despite patient perceptions, the lack of coordination for older adults is repeatedly pointed to as a weakness in France.” There is nothing similar to the patient-centered medical home concept.
Jennifer Dixon, Ph.D., chief executive of The Health Foundation in the United Kingdom, a nonprofit research and policy analysis organization, discussed the challenges of working within Britain’s National Health Service. The NHS provides universal coverage funded through general taxation, user charges and national insurance contributions. Overall the U.K. rated highly in access to care, had few cost-related barriers, low use of the emergency department and avoidable ED visits.
“However, care coordination between the primary physician and specialists is a concern,” she said. Another major concern is that without further tax contributions, maintaining quality of care and universal access to comprehensive care is increasingly difficult. Severe cuts in social care – such as cleaning, shopping, adult day and respite care, and caregiver support programs for those who qualify — are begin this year.
Cost of care is, of course, an ongoing issue in the U.S. While the United States has a “younger” senior population compared with other countries, it spends more for health care for this group, said Donald Moulds, Ph.D., executive vice president for programs at The Commonwealth Fund. The U.S. has the highest proportion of older adults with two or more chronic conditions (68 percent) among the 11 countries surveyed. “The sickest 10 percent of older adults account for 65 percent, or almost two thirds, of health expenses,” he said.
Americans also reported the most cost-related access to care problems compared with other nations. “That results in higher emergency department use, which drives up costs.” On the positive side, the U.S. experienced the fewest gaps in hospital discharge planning compared with the other nations in the survey.
The majority of U.S. respondents (55 percent) have written plans for end-of-life care and two-thirds (67 percent) have named a health care proxy. In comparison, only 20 percent of older adults in the U.K. and just 5 percent of those in France have written end-of-life care goals; 47 percent of seniors in the U.K. and 16 percent in France have named a health proxy.
“There is room for improvement in all countries,” Moulds said. “Especially in care coordination and in self-care.” A greater focus on patient-centered medical homes and increased support for social services is vital to caring for high needs, high cost patients, regardless of location.
The experts agreed that this annual survey provided a good starting point for providers and policy experts to learn from one another as they confront similar challenges within different systems.