title: International survey of older adults finds shortcomings in access, coordination, and patient-centered care.
abstract: Industrialized nations face the common challenge of caring for aging populations, with rising rates of chronic disease and disability. Our 2014 computer-assisted telephone survey of the health and care experiences among 15,617 adults age sixty-five or older in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States has found that US older adults were sicker than their counterparts abroad. Out-of-pocket expenses posed greater problems in the United States than elsewhere. Accessing primary care and avoiding the emergency department tended to be more difficult in the United States, Canada, and Sweden than in other surveyed countries. One-fifth or more of older adults reported receiving uncoordinated care in all countries except France. US respondents were among the most likely to have discussed health-promoting behaviors with a clinician, to have a chronic care plan tailored to their daily life, and to have engaged in end-of-life care planning. Finally, in half of the countries, one-fifth or more of chronically ill adults were caregivers themselves.
authors.affiliation: Robin Osborn (ro@cmwf.org) is vice president and director of the International Health Policy and Practice Innovations program at the Commonwealth Fund, in New York City.
authors.forename: Robin
authors.initials: R
authors.lastname: Osborn
authors.affiliation: Donald Moulds is executive vice president for programs at the Commonwealth Fund.
authors.forename: Donald
authors.initials: D
authors.lastname: Moulds
authors.affiliation: David Squires is senior researcher to the president at the Commonwealth Fund.
authors.forename: David
authors.initials: D
authors.lastname: Squires
authors.affiliation: Michelle M. Doty is vice president of survey research and evaluation at the Commonwealth Fund.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Doty
authors.affiliation: Chloe Anderson is a research associate in the International Health Policy and Practice Innovations program at the Commonwealth Fund.
authors.forename: Chloe
authors.initials: C
authors.lastname: Anderson
mesh_terms: D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy; D003266:Continuity of Patient Care / Q000706:statistics & numerical data; D019049:Developed Countries / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006299:Health Services for the Aged / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D061214:Patient Safety / Q000706:statistics & numerical data; D018802:Patient-Centered Care / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D013727:Terminal Care / Q000706:statistics & numerical data
keywords: Access To Care; Chronic Care; Developed World < International/global health studies; Long-Term Care; Medicare