Health care systems across highincome countries share the challenge of an aging population with unprecedented levels of chronic illness.1 Often these older adults are living with frailty, advanced illness, or diminished ability to manage the basic activities of daily living, such as preparing meals, bathing, or managing one’s medications. Across countries, health care spending is concentrated among these older patients, whose complex needs are often at odds with health care systems designed to treat patients needing acute episodic care.
This article uses data from the 2017 Commonwealth Fund International Health Policy Survey of Older Adults, the twentieth study in this international series, to report on the challenges that elderly adults (those ages sixty-five and older) face across eleven countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. For the first time we show cross-national data on the prevalence of social isolation and material hardship among the elderly, recognizing the impact that social determinants may have on health, health care use, and outcomes.
The 2017 survey also introduces key performance measures for a subpopulation of highneed elderly people, defined as those who have three or more chronic conditions or need help with activities of daily living because of a health problem. Focusing on the experiences of highneed patients has become increasingly important for policy makers and health care delivery systems because the members of this population are frequent users of health and social care systems and account for a disproportionate share of total health care spending.2
This analysis compares how well US seniors fare under Medicare relative to the elderly in ten other high-income countries that provide universal health insurance coverage for this population, but differ from the United States in how health care is financed and organized, and in the social services support provided to the most economically vulnerable. The analysis also raises the issue of how the proportion of spending allocated to health versus social services differs across countries.3
Despite these differences, all eleven countries in the survey are engaged in ongoing health care reforms and efforts to transform delivery systems to better support patients with complex illnesses and elderly people in the community.4 The 2017 survey findings offer a unique opportunity for cross-national learning.
– Health Affairs