title: Comparison of Health Care Experience and Access Between Young and Older Adults in 11 High-Income Countries.
abstract: OBJECTIVE
  Young adults (18-24 years) frequently report poorer health care access and experience than older adults. We aimed to investigate how differences between young and older adults vary across 11 high-income countries.
  
  
  METHODS
  A total of 20,045 participants from 11 high-income countries (i.e., Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, United Kingdom, United States) participating in the Commonwealth Fund 2013 International Health Policy Survey. We compared young adults (18-24 years) with older adults (25-34; 35-49; 50-64; 65+ years) on three aspects of health care: overall satisfaction, cost barriers to access, and four indicators of consultation quality relating to adequate information, time, involvement, and explanation.
  
  
  RESULTS
  Across all participants, young adults reported significantly worse overall satisfaction (63.6% vs. 70.3%; p < .001) and more frequent cost barriers (21.3% vs. 15.2%; p < .001) than older adults. Country-level analyses showed that young adults reported lower overall satisfaction than older adults in five of 11 countries (Australia, Canada, Norway, Switzerland, United States) and more frequent cost barriers in six of 11 countries (Canada, France, Germany, Switzerland, Norway, United States). In five countries (Australia, Canada, France, Norway, Switzerland), most patient experience indicators were less positive among young adults than those among older adults. In three countries (Netherlands, New Zealand, United Kingdom), there was no significant difference between young and older adults on any indicator.
  
  
  CONCLUSIONS
  Associations between age and health care access/experience varied markedly between countries, suggesting that poor access and experience among young adults is not inevitable and may be amenable to policy/practice interventions.
authors.affiliation: Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts; Population, Policy & Practice Programme, UCL Institute of Child Health, London, United Kingdom. Electronic address: Dougal.Hargreaves@childrens.harvard.edu.
authors.forename: Dougal S
authors.initials: DS
authors.lastname: Hargreaves
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, Charing Cross Hospital, London, United Kingdom.
authors.forename: Felix
authors.initials: F
authors.lastname: Greaves
authors.affiliation: Department of Business Administration, Lund University, Lund, Sweden.
authors.forename: Charlotta
authors.initials: C
authors.lastname: Levay
authors.affiliation: Department of Medicine, Australian National University, Canberra Hospital, Canberra, Australia.
authors.forename: Imogen
authors.initials: I
authors.lastname: Mitchell
authors.affiliation: Institute for Primary Care, University of Zürich, UniversitätsSpital Zürich, Zürich.
authors.forename: Ursula
authors.initials: U
authors.lastname: Koch
authors.affiliation: Division of Integrative Health Promotion, Coburg University of Applied Sciences, Coburg, Germany; Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Tobias
authors.initials: T
authors.lastname: Esch
authors.affiliation: Department of Paediatrics, Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Simon
authors.initials: S
authors.lastname: Denny
authors.affiliation: Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
authors.forename: Jan C
authors.initials: JC
authors.lastname: Frich
authors.affiliation: National Institute for Public Health and Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Struijs
authors.affiliation: Centre for Population Health Sciences, Medical School, Edinburgh, United Kingdom.
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D055812:Community-Based Participatory Research; D017281:Cost of Illness; D019049:Developed Countries / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Access and evaluation; Health care quality; Health care systems; Patient experience; Young adults