Comparison of health care experience and access between young and older adults in 11 high-income countries

Purpose
Young adults (18–24 years) frequently report poorer health care access and experience than older adults. We aimed to investigate how differences between young and older adults vary across 11 high-income countries.

Methods
A total of 20,045 participants from 11 high-income countries (i.e., Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, United Kingdom, United States) participating in the Commonwealth Fund 2013 International Health Policy Survey. We compared young adults (18–24 years) with older adults (25–34; 35–49; 50–64; 65+ years) on three aspects of health care: overall satisfaction, cost barriers to access, and four indicators of consultation quality relating to adequate information, time, involvement, and explanation.

Results
Across all participants, young adults reported significantly worse overall satisfaction (63.6% vs. 70.3%; p < .001) and more frequent cost barriers (21.3% vs. 15.2%; p < .001) than older adults. Country-level analyses showed that young adults reported lower overall satisfaction than older adults in five of 11 countries (Australia, Canada, Norway, Switzerland, United States) and more frequent cost barriers in six of 11 countries (Canada, France, Germany, Switzerland, Norway, United States). In five countries (Australia, Canada, France, Norway, Switzerland), most patient experience indicators were less positive among young adults than those among older adults. In three countries (Netherlands, New Zealand, United Kingdom), there was no significant difference between young and older adults on any indicator.

Conclusions
Associations between age and health care access/experience varied markedly between countries, suggesting that poor access and experience among young adults is not inevitable and may be amenable to policy/practice interventions.