How High-Need Patients Experience the Health Care System in Nine Countries

Dana O. Sarnak
Jamie Ryan
January 2016

This resource reviews Commonwealth Fund survey data focused on high-need adults ages 65 and older in nine countries — Australia, Canada, France, Germany, the Netherlands, Norway, Sweden, Switzerland, and the United States. Findings included the following:

  • The U.S. had the highest percentage of older adults with three or more chronic conditions (42 percent).
  • The U.S. had the highest rate of cost-related access problems for all older adults, especially high-need patients. More than 1 in 5 high-need adults in the U.S. (22 percent) reported cost-related barriers to care.
  • The U.S. performed better than all the other countries in contacting patients between visits and providing treatment plans. Nearly 9 of 10 high-need adults in the U.S. (87 percent) reported that they had a treatment plan.
  • Success in other countries may be the result of policies that specifically target high-need patients. Further analysis of these policies and their key features can help U.S. policymakers better target care to high-need patients.
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Population Addressed
Adults Under 65 with Disabilities
Frail Older Adults
People with Multiple Chronic Conditions
People with Behavioral Health and Social Needs
Key Questions Answered
  • How does the U.S. compare with other high-income countries in terms of care for high-need individuals?
  • What lessons can the U.S. learn from other countries?
Level of Evidence
What does this mean?