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Despite Health System Issues, Older U.S. Patients Satisfied With Physicians

NEW YORK – Healthcare in the United States may fall short of other industrialized nations in some ways, but, as much as anywhere else, older patients in this country reported good relationships with their doctors.

That’s according to a new report, published recently in the journal Health Affairs, from the Commonwealth Fund.

Researchers conducted a computer-assisted telephone survey of the health and care experiences of 15,617 adults 65 or older in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.

Older adults in the U.S. tended to be sicker than those in other industrialized nations. For them, out-of-pocket expenses, accessing primary care and avoiding the emergency department also were greater problems than for older patients in most of the other countries surveyed.

On the other hand, U.S. 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, according to the report.

Most of the respondents, ranging from 79% in Sweden to 94% in both France and the Netherlands, said they felt as if their doctors spent enough time with them, and most also said they were encouraged during office visits to ask questions about their health and care.

“American respondents were particularly likely to report that their doctors had discussed with them how to live a healthy life,” the authors write. “The United States was at or near the top in the reported frequency with which doctors discussed diet or exercise (76%) and stress (29%) with their patients.”

The United States, with the United Kingdom, also was one of the top performers when it came to receiving support from providers in managing chronic conditions. Nearly 60% of older patients in those two countries said they were able to discuss their goals in caring for their conditions and received clear instructions when to seek further care. Fewer than half of patients in the other surveyed nations had that response.

Researchers note that industrialized nations are trying to “retrofit” their current health care delivery systems, originally designed to treat acute illnesses, to better manage chronic diseases.

The report points out that, In the United States, 85% of all health care services are currently used by people with at least one chronic disease, and $140 billion of Medicare spending in 2010 – almost half of total expenditures – goes for care of the 14% of Medicare beneficiaries with six or more chronic conditions.

“With older patients often receiving care from multiple providers, taking multiple prescription drugs, and managing complicated care regimens, these people are vulnerable to health system failures that can result in fragmented and poorly coordinated care, as well as costly and injurious medical errors,” the authors write.