Comparing health care for older adults across 23 countries

How well do different countries take care of their elderly and near elderly populations? A study by Macinko et al. (2020) provides some useful statistics.

Methods

Population of interest. Individuals aged 50 and above sampled across 23 high- and middle-income countries.

Data. The data come from 2015 or 2016 years for the following data sets: Brazilian Longitudinal Study of Aging; Mexican Health and Aging Study; Korean Longitudinal Study of Ageing; Survey of Health, Ageing and Retirement in Europe, which includes Austria, Belgium, Croatia, Czech Republic, Denmark, Estonia, France, Germany, Greece, Israel, Luxembourg, Italy, Poland, Portugal, Slovenia, Spain, Sweden, and Switzerland; Chinese Health and Retirement Longitudinal Study; Health and Retirement Study in the US. While these are large, robust data sources, about 18% of the sample was dropped due to missing variables.

Measures. The measures included: (i) whether individuals had a doctors visits in the past year (as a measure of access to care); (ii) more than 15 doctors visit the past year (to indicate over-utilization), (iii) two or more hospitalizations in the past year, and (iv) whether health expenditures reached 25% of household income. While this measure are easily accessible across a number of different countries, they are very crude.

Results

Access: “About 11 percent of respondents reported having no doctor visit in the previous year. But this figure varied considerably, with two countries (Czech Republic and Luxembourg) reporting rates of less than 5 percent and two countries (Greece and Mexico) reporting approximately 23 percent of adults without a doctor visit in the past year.”

Excess utilization. This was largely the reverse of the access story. Nine percent of the sample reported ≥15 doctor visits in the past year, ranging from a low of <5% in Brazil and Mexico to a high of nearly 16% in Italy.

Two Hospitalizations. The lowest rate (<2% of individuals) was observed in South Korea, whereas the highest rate (>9% of individuals) was observed in Mexico and the US .

Catastrophic cost. European countries were the best performers here. In Denmark, France, Germany, and Sweden <1% of people had health care costs reach >25% of their income, whereas for >10% of the elderly in Brazil, China, Mexico, and South Korea had health care costs >25% of their income.

Do read the whole article if you are interested more of these statistics.

While one should be careful of interpreting these results as clearly indicating whether a health care system is good or bad–for instance, quality of care is not well-measured–these are helpful basic statistics for cross country comparisons.

Source:

Macinko J, Cristina Drumond Andrade F, Bof de Andrade F, Lima-Costa MF. Universal Health Coverage: Are Older Adults Being Left Behind? Evidence From Aging Cohorts In Twenty-Three Countries: Study examines access to care, use, catastrophic expenditures, and other factors among several aging cohorts in twenty-three countries. Health Affairs. 2020 Nov 1;39(11):1951-60.

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