Health Care for Older Persons in England and the United States: A Contrast of Systems and Values

Abstract

This article extends previous comparisons of access to health care for older persons in England and the United States by comparing rates of avoidable hospital conditions as a proxy for primary care access and by examining the distribution of care within these older populations. Drawing on hospital data from the two countries, we find that older persons in the United States, particularly those over the age of seventy-five, receive far more revascularizations than do older persons in England. Differences in the use of lower-joint replacement are not as great, but we are unable to assess differences in the need for these procedures. Although older persons have greater access to specialty care in the United States, there appears to be much better access to primary care in England. We are unable to draw comparisons on the extent of inequalities in access to health care, although in the United States there is evidence of inequalities in access by race, and in England we confirm earlier studies that find inequalities by level of deprivation. These findings are discussed in the context of the political debates over access to care and rationing in the two countries.

Estimated burden of cardiovascular disease and value-based price range for evolocumab in a high-risk, secondary-prevention population in the US payer context

“…Notably, the HES data that we analyzed covered inpatient stays only, and many PCI procedures are performed in the outpatient setting in the US, so actual US primary composite outcome rates may be higher 44 . Also, revascularization rates are substantially higher in the US compared with the UK 45,46 . As a result, the value-based price for evolocumab could have been under-estimated.…”

Ethics of Resource Allocation and Rationing Medical Care in a Time of Fiscal Restraint - US and Europe

“…However, PPACA does little to address rising health care expenditure, 30 as an explicit discussion of rationing remains politically anathema in the US. 13 What seems to be urgently needed in both the US and Europe are public debates about the financial sustainability of health systems, the trade-offs between cost-containment and broader societal and health system goals (such as increased population coverage and investment in other social goods), the role of the welfare state, and where the limits of publicly financed health care should be. …”

“…The US, where social welfare remains politically controversial, places few restrictions on publicly financed health care technology, such as in the Medicare and Medicaid programs, regardless of cost or clinical effectiveness. 13 European countries, on the other hand, are more willing to engage in explicit debates about what the limits of publicly funded health care should be. However, they face difficulties in putting these debates on a rational basis and limiting media and lobby power, with implications for the values that underpin decisions.…”

“…9,12 However, this does not regularly happen in practice and it is often easier for governments (or, in the US, employers) to instead exclude whole areas of services, such as dental care. 8 Furthermore, much "bedside" rationing by clinicians, such as on the basis of age, 13 has been traditionally implicit and unsystematic. 11,12 …”

Health Systems Performance and the Politics of Cancer Survival

“…Patients that do not have health insurance or who live in poor neighborhoods are less likely to receive primary or specialty care than wealthier patients with insurance (Gusmano, Rodman, & Weisz, ). Glied and Little () argued that “more than $1.1 billion is lost annually from excess morbidity and mortality among the uninsured population because of lack of access to new technologies for the treatment of heart attacks, cataracts and depression, alone.” Similarly, racial and ethnic minorities and women also face significant barriers to care, regardless of insurance status (Gusmano & Allin, ).…”