Skip to main content
Log in

Financing care for aging women in the U.S.: International perspectives

  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

The aging of the U.S. population presents challenges in financing care and meeting the health and long-term care needs of older Americans. Women, who constitute a majority of the older adult population and a disproportionate share of those with low incomes, chronic conditions and long-term care needs, have much at stake in the future direction of health programs for aging Americans. This paper examines the status of older women in 12 industrialized nations to assess how the U.S. compares to other countries in terms of its aging female population. We find that women across the 12 industrialized countries have a longer life expectancy than men at ages 65 and 80, underscoring the universality of aging as a “women’s issue”. With respect to age composition, the U.S. lags behind many industrialized nations in the share of its elderly female population; by 2030, the proportion of women aged 65 and older, and 80 and older, will be lower in the U.S. than in any of the industrialized nations compared in this paper. Against this backdrop, the paper examines the characteristics of older adult women in the U.S., considers the role of Medicare in meeting the needs of aging women, and identifies gaps in coverage, primarily prescription drug and long-term care, that disproportionately affect older women. The paper concludes by considering how other nations provide and finance prescription drug and long-term care services for older adults, suggesting useful models for the U.S. to consider as it struggles to meet the demands of its aging population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Fried L.P., Guralnik J.M.: Disability in older adults: evidence regarding significance, etiology, and risk. J. Am. Geriatr. Soc. 45: 92–100, 1997.

    CAS  PubMed  Google Scholar 

  2. Social Security Administration (SSA): Social security programs throughout the world — 1997. Research Report #65, SSA Publication Number 13-11805. U.S. Government, Washington, D.C., 1997.

    Google Scholar 

  3. Reinhardt U.: Can twenty-first century America afford health care for its growing number of elderly citizens? Testimony before the United States Senate Budget Committee, Hearing on Long Term Budget Projections and Issues, Feb. 25, 1998.

    Google Scholar 

  4. U.S. Census Bureau: May 1999 resident population estimates of the United States by age and sex. Population Estimates Program, Population Division, U.S. Census Bureau, Washington, D.C., June 25, 1999.

    Google Scholar 

  5. Organization for Economic Cooperation and Development: OECD Health Data 98: A comparative analysis of 29 countries. Organization for Economic Cooperation and Development, Paris, 1998.

    Google Scholar 

  6. Kaiser Family Foundation: Women and Medicare (fact sheet). May, 1999.

    Google Scholar 

  7. U.S. Census Bureau: Marital status and living arrangements: detailed tables. Current Population Survey. U.S. Census Bureau, Washington, D.C., March 1998.

    Google Scholar 

  8. Rice D.P.: Beneficiary profile: yesterday, today, and tomorrow. Health Care Financing Review 18: 23–45, 1996.

    CAS  PubMed  Google Scholar 

  9. Authors calculations using data from the 1996 Medicare Current Beneficiary Survey.

  10. Health Care Financing Administration: 1996 Medicare Current Beneficiary Survey.

  11. U.S. Census Bureau: 1997 Poverty Guidelines. Federal Register 62: 10856–10859, 1997.

    Google Scholar 

  12. Rowland D., Lyons B.: Medicare, Medicaid, and the elderly poor. Health Care Financing Review 18: 23–45, 1996.

    Google Scholar 

  13. Cassell C.K, Besdine R.W., Siegel L.C.: Restructuring Medicare for the next century: what will beneficiaries really need? Health Aff. 18: 118–131, 1999.

    Article  Google Scholar 

  14. Blustein J.: Medicare and drug coverage: A women’s health issue. Paper presented at meeting of The Jacobs Institute of Women’s Health and the Commonwealth Fund, “Women and Medicare: Agenda for Change”, September 16, 1999.

    Google Scholar 

  15. Davis M., Poisal J., Chulis G., Zarabozo C., Cooper B.: Prescription drug coverage, utilization, and spending among Medicare beneficiaries. Health Aff. 18: 231–243, 1999.

    Article  CAS  Google Scholar 

  16. Gluck M.E.: Potential Medicare coverage of outpatient prescription drugs. Testimony before the United States Senate Committee on Finance, Hearing on considerations for a Medicare Prescription Drug Benefit, June 23, 1999.

    Google Scholar 

  17. Gibson M.J., Brangan N.: Out of pocket spending on health care by women age 65 and over in fee-for-service Medicare: 1998 projections (AARP/Public Policy Institute fact sheet). American Association for Retired People, Washington, D.C., 1998.

    Google Scholar 

  18. Kaiser Commission on Medicaid and the Uninsured: Medicare and Medicaid for the elderly and disabled poor (fact sheet). May, 1999.

    Google Scholar 

  19. Health Care Financing Administration www.hcfa.gov/stats/nhe-oact/tables/t9/htm, 2000.

  20. Feder J.: Medicare beneficiaries with chronic conditions and long-term care needs: an overview. Presentation before the Reform Task Force of the National Bipartisan Commission on the Future of Medicare, Sept. 29, 1998.

    Google Scholar 

  21. Leon J., Neuman P., Parente S.: Understanding the growth in Medicare’s home health expenditures. Report prepared for the Henry J. Kaiser Family Foundation, Menlo Park, California, June 1997.

    Google Scholar 

  22. Health Care Financing Administration: A profile of Medicare: home health chart book. August, 1999.

    Google Scholar 

  23. Murtaugh C., Kemper P., Spillman B., Carlson B.: The amount, distribution, and timing of lifetime nursing home use. Med. Care 35: 204–218, 1997.

    Article  CAS  PubMed  Google Scholar 

  24. Komisar H.L., Lambrew J.M., Feder J.: Long-term care for the elderly (chart book). The Commonwealth Fund, New York, December 1996, pp. 12–13.

    Google Scholar 

  25. Pear R.: Medicare panel, sharply divided, submits no plan. New York Times, page A1, March 17, 1999.

    Google Scholar 

  26. National Economic Council and Domestic Policy Council: The President’s plan to modernize and strengthen Medicare for the 21st century (report). National Economic Council and Domestic Policy Council, Washington, D.C., Ju1y 2, 1999.

    Google Scholar 

  27. Pear R.: Clinton seeks aid for care of those with chronic ills. New York Times, page A1, January 4, 1999.

    Google Scholar 

  28. Anderson G.F., Poullier J.: Health spending, access, and outcomes: trends in industrialized countries. Health Aff. 18: 178–192, 1999.

    Article  CAS  Google Scholar 

  29. Anderson G.F., Hussey P.S.: Population aging: a comparison among industrialized countries. Health Aff. 19, 2000 (in press).

  30. Hutton J., Borowitz M., Oleksy I., Luce B.R.: The pharmaceutical industry and health reform: lessons from Europe. Health Aff. 13: 98–111, 1994.

    Article  CAS  Google Scholar 

  31. Naylor D.C.: Health care in Canada: incrementalism under fiscal duress. Health Aff. 18: 9–26, 1999.

    Article  CAS  Google Scholar 

  32. Minister of Public Works and Government Services: Canada Health Act Annual Report, 1996–1997. Minister of Public Works and Government Services, Canada, 1997.

    Google Scholar 

  33. Japan. In: Caring for frail elderly people: Policies in evolution. Organization for Economic Cooperation and Development, Paris, 1996, pp. 143–154.

    Google Scholar 

  34. Peabody J.W.: The Australian health care system: are the incentives down under right side up? JAMA 276: 1944–1950, 1996.

    Article  CAS  PubMed  Google Scholar 

  35. Kirkmann-Liff B.L.: Healthcare Reform in the Netherlands, Israel, Germany, England, and Sweden. Generations 20: 65–70, 1996.

    Google Scholar 

  36. Sweden. In: Caring for frail elderly people: Policies in evolution. Organization for Economic Cooperation and Development, Paris, 1996, pp. 165–176.

    Google Scholar 

  37. Harrington C., Pollock A.M.: Decentralisation and privatisation of long-term care in U.K. and U.S.A. Lancet 351: 1805–1809, 1998.

    Article  CAS  PubMed  Google Scholar 

  38. Weiner J., Cuellar A.E.: Public and private responsibilities: home and community-based services in the United Kingdom and Germany. Journal of Aging and Health 11: 417–444, 1999.

    Article  Google Scholar 

  39. Filinson R.: Legislating community care: the British experience, with U.S. comparisons. Gerontologist 37: 333–340, 1997.

    Article  CAS  PubMed  Google Scholar 

  40. Older Australia at a glance: Home and Community Care (HACC) program (report) [online]. Australian Institute of Health and Welfare, Canberra, Australia, 1997.

    Google Scholar 

  41. Ribbe M.W., Ljunggren G., Steel K., Topinkova E., Hawes C., Ikegami N., Henrard J., Jonnson P.V.: Nursing homes in 10 nations: a comparison between countries and settings. Age Ageing 26: S3–S13, 1997.

    Article  Google Scholar 

  42. Schunk M.: The social insurance model of care for older people in Germany. In: Glendinning C. (Ed.), Rights and realities: Comparing new developments in long-term care for older people. Policy Press, Bristol, 1998, pp. 29–46.

    Google Scholar 

  43. France. In: Caring for frail elderly people: Policies in evolution. Organization for Economic Cooperation and Development, Paris, 1996, pp. 131–141.

    Google Scholar 

  44. Ikegami N.: Public long-term care insurance in Japan. (Letter from Tokyo). JAMA 278: 1310–1315, 1997.

    Article  CAS  PubMed  Google Scholar 

  45. OECD Economic Surveys — Japan. Organization for Economic Cooperation and Development, Paris, 1998, p. 51.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to P. H. Neuman Sc.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Neuman, P.H., Rice, D.P. & Hussey, P.S. Financing care for aging women in the U.S.: International perspectives. Aging Clin Exp Res 12, 154–164 (2000). https://doi.org/10.1007/BF03339901

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03339901

Key words

Navigation