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Good news/bad news story for older Americans

Westchester County Business Journal, July 08, 2002

There’s good news and bad news about the health security of Americans age 50+, as highlighted in a new report from AARP. Americans age 50+ are healthier and living longer overall, but their long-term health security remains at risk.

The report finds some unexpected age and economic groups are threatened with losing essential healthcare components such as insurance coverage and access to care. “Beyond 50: A Report to the Nation on Trends in Health Security,” released by AARP, is the most comprehensive picture to date of the state of health care for midlife and older Americans. It’s the second in a series of annual reports from AARP on the status of Americans age 50 and over.

“Americans age 50+ have the chance to capitalize on wonderful advances in medical care and public health. But they need a chain of dominoes to fall right — initial good health, adequate health care coverage, access to quality care and a system that encourages informed decision-making,” said AARP policy and strategy director John Rother. “Missing one of these dominoes puts a person’s — and a generation’s — whole health security at risk.”

Among the report’s highlights:

At age 50, Americans can expect to live another 30 years, almost nine years longer than expected in 1900, and fewer are suffering disabilities.

Although Americans age 50+ are healthier, with fewer smoking and more using preventive services and trying to exercise, obesity could cancel out many of the gains.

More people age 50 to 64 are uninsured than in the past, but even those with insurance are worried about losing what coverage they have or receiving fewer benefits in the future. Medicare doesn’t cover prescription drugs and few Americans have long-term care insurance. Out-of-pocket spending on long-term care and spending on prescription drugs represent the greatest health-related financial risks for older Americans.

About one in five Americans age 50 and older say they or their spouse help a disabled relative or friend with everyday activities. Caregivers age 50+ average more than 20 hours of care per week. More than half provide this care five years or more.

DRAMATIC INCREASE IN COSTS

Average total healthcare spending among Americans 50 and older rose 310 percent, nearly twice as fast as inflation. That figure excludes nursing home costs. More than four in 10 with lower incomes spent 10 percent or more of their income on health care.

There’s a generation gap in healthcare expectations and behavior.

Fifty- to 64-year-olds expect more and want more control of their health care. But control is harder to exercise as healthcare systems become increasingly complex and fragmented.

Health care perceptions and preferences of the 50+ population often conflict with reality. Many misjudge quality of care, misunderstand long-term care and its costs, or overestimate the extent to which pain at the end of life is actually being controlled.

“It’s a good news/bad news report,” said Rother. “Personal behavior can make a positive difference in people’s health and longevity, but health care for Americans age 50+ is harder to get, to pay for, and to manage. The health care system is a non-system.”

To ensure access to and delivery of high-quality, affordable care so people live longer and healthier, the report concludes that certain policy implications cannot be ignored.

Solutions must address a population of midlife and older Americans that is increasingly more racially and ethnically diverse.

Health and long-term care systems must emphasize improved quality of life and the need for people to be active and function independently — not just live longer.

The public health system needs to be strengthened to better promote positive health behaviors, deliver services, control environmental risks and contribute to an information infrastructure that enables individuals to better manage their health and health care.

Addressing the general lack of long-term care coverage and the increasing inadequacy and instability of health care coverage, including prescription drugs, should be a priority.

Public/private collaboration is needed on a health information system that will facilitate improvements in clinical care as well as help individuals navigate increasingly complex and fragmented health care systems. Health literacy requires particular attention.

Changes in health security during the last 20 years have been driven by increased reliance on prescription drugs and other innovative technologies, changes in chronic disease and challenges in chronic care, greater longevity with functional limitations, patients roles and responsibilities as consumers, and fluctuating cost growth, the report finds.