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Figure 13

How the Elderly Evaluate Their Health Care

51%

40%

U.K.

Canada

U.S.

23%23%

14%

14%

11%13%

10%

7%

4%

4%

Long Wait for

Received

Experienced Long Difficulty Gaining

Serious Surgery

Inadequate

Acces s to a

Wait for

Outpatient

Specialis t

Nonemergency

Services

Surgery

During the 1990s,

Source: Cathy Schoen et al., “The Elderly's Experiences with Health Care in Five Nations,” Commonwealth

Fund, May 2000.

health care

spending in all

die than other Australians. Despite the greater

groups sampled had much less access to

but 3 of 15 OECD

overall health needs of these populations, minori-

health care than Caucasians--despite their

greater health needs.76 Futher, health dispar-

countries studied

ties in countries with national health insurance

systems are routinely marginalized by systems

ities persisted between Canadian Indians and

grew at about the

that direct resources and services toward the

Caucasians. The infant death rate during the

same rate as in

more affluent, white, urban majority.

study period was 13.8 per 1,000 live births for

If the experience of other countries is any

Indian infants and 16.3 per 1,000 for Inuit

the United

guide, the elderly have the most to lose under

infants, approximately twice the rate (7.3 per

States--or higher.

a national health insurance system. In general,

1,000) of that for all Canadian infants during

when health care is rationed, the young get

the same period. Overall, Canadian aborigi-

preferential treatment, while older patients get

nal people "die earlier than their fellow

pushed to the rear of the waiting lines.

Canadians and sustain a disproportionate

In Britain, many elderly do not receive the

share of the burden of physical disease and

mental illness."77

treatment and specialized care they need.

Although more than one-third of all diag-

In New Zealand, the same disparities persist.

nosed cancers occur in patients 75 years of

The average life expectancy for Maori men (68

age or older, most cancer-screening programs

years) is 5.5 years less than for non-Maori men.

in the NHS do not include people over age

The average for Maori women (73 years) is six

years less than for non-Maori women.78 Further-

65.80 Only one in 50 lung cancer patients over

age 75 receives surgery.81

more, those Maori who live in the least deprived

areas live seven years longer than those in the

New Zealand's guidelines for end state

most deprived areas. The corresponding figure

renal failure programs say that age should

for women is eight years. Australia also has a sig-

not be the sole factor in determining eligibil-

nificant minority population (the Aborigines).

ity, but that "in usual circumstances, people

Various studies have reported that death rates are

over 75 should not be accepted." Since New

higher for Aborigines in all age groups.79 In infan-

Zealand has no private dialysis facilities, this

amounts to a death sentence for elderly

cy, Aborigines are 3.1 to 3.5 times more likely to

patients with kidney failure.82

die than other Australians. In the 35 to 54 age

group, they are six to seven times more likely to

Although there is very little relationship

14