NEW YORK, May 08 (Reuters Health) - Elderly people are generally positive about the healthcare they receive but express grave concerns about the future cost of care, results of a new international study indicate.

In the United States and New Zealand in particular, a majority of the elderly would like to see a major overhaul of healthcare services, researchers report in the May/June issue of the journal Health Affairs. Older adults in those two countries also were found to be more worried about paying for long-term care.

While the paper shows that healthcare is generally working well in the five nations surveyed, the authors suggest that the protections put in place by each nation could erode as their populations age and the number of retirees expands. People are worried about not having enough money for retirement and the future cost of acute and long-term care services, Karen Donelan of the Harvard School of Public Health in Boston, Massachusetts, and colleagues note.

The Health Affairs report is based on results of a survey of non-institutionalized elderly aged 65 or older in Australia, Canada, New Zealand, the United Kingdom, and the US. Researchers from the Harvard School of Public Health, Harris Interactive and The Commonwealth Fund collaborated in designing the survey, which took place from April to June 1999.

In all five countries, the elderly were most likely to report that their healthcare systems needed only minor tweaking. Respondents in New Zealand and the US expressed the most negative views, with 31% and 26%, respectively, expressing the opinion that their healthcare systems needed to be completely rebuilt.

In addition, fewer than one quarter of the respondents in each of the five nations agreed that medical care for the elderly has improved over the past 5 years.

The survey also finds no major problems with access to care. "There is strong evidence that the universal systems in place in these countries provide financial protection to the older, sicker populations and reasonable access to care," researchers report.

Yet in every nation except Canada, 20% or more of the respondents said that they are having difficulty paying for the basic costs of living. That underscores the importance of having health coverage, the authors suggest.

In the area of drug coverage, the paper highlights a major divide. Fully 32% of Americans lack coverage for prescription drugs, versus 1% to 16% of elderly in the four other industrialized nations. Furthermore, 16% of American respondents reported spending more than $100 a month out-of-pocket for prescription drugs, compared with fewer than 5% in the other four countries.

The data are particularly relevant in context of the current US debate over creating a Medicare prescription drug benefit, observe Donelan and colleagues.

Additional survey findings were released on Monday by The Commonwealth Fund in a new report, The Elderly's Experiences with Health Care in Five Nations.

"These results reveal that Medicare goes a long way toward assuring access to healthcare for older populations--in stark contrast to adults under age 65, where the US lags behind other counties," notes Karen Davis, president of The Commonwealth Fund. The major disparity, she said, is in access to prescription drugs.

SOURCE: Health Affairs 2000;19:228-236.

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