Researchers say lack of health insurance coverage is a big reason older adults in the United States lag behind seniors in other developed nations.

The United States may not be the best place to be a senior citizen.

A recent study that examined the health of people aged 65 years and older in the United States and 10 other high-income countries found that American seniors were sicker and more likely to face barriers in accessing healthcare than their counterparts in other countries.

The authors of the study, which drew on findings from the 2017 Commonwealth Fund International Health Policy Survey of Older Adults, said health insurance coverage in the United States likely plays a big role.

“Unlike other surveyed countries, adults in the United States do not have universal health insurance coverage until they reach age 65. This means that prior to getting Medicare at age 65, millions of adults may have a history of lacking health insurance,” Michelle Doty, MPH, PhD, co-author of the study and vice president of survey research and evaluation at the Commonwealth Fund, told Healthline.

“When people lack insurance, they are more likely to put off getting preventive care, skip or not fill prescription drugs, and forgo seeing a doctor even when they are sick,” she added. “Gaps in coverage and preventive care during Americans’ working years results in an older population that ages into Medicare with unmanaged chronic illness.”

About 43 percent of senior citizens in the United States are categorized as high need.

That means the person has multiple chronic conditions or requires assistance with daily activities like cooking.

Almost a quarter (23 percent) of seniors in the United States reported that, in the past year, they skipped recommended tests or treatments, didn’t fill prescriptions, skipped medication doses, or didn’t visit a doctor because of the cost.

This is in contrast to other surveyed countries such as France, Norway, Sweden, and the United Kingdom, where less than 5 percent of respondents reported such struggles.

One-quarter of U.S. respondents said they are often worried about having enough money to pay for nutritious meals or housing.

Dr. Paul Mulhausen, a geriatrician and spokesperson for the American Geriatrics Society, says this points to a need for better social services for older adults.

“In the U.S., relative to other OECD [Organization for Economic Cooperation and Development] countries, we spend a disproportionate amount of our resources on healthcare as opposed to social services care like pensions, family support, and housing support,” Mulhausen told Healthline. “I think that may explain some of the issues surrounding not having enough money to buy nutritious meals and issues around rent or mortgage.”

Mulhausen says the costs for older people to stay independent and healthier in their own homes for longer are also challenging.

“Home care services and nursing home care come out of your pocket, so there are huge barriers to people using those kinds of services to help them stay more independent or healthier at home,” he said.

The number of seniors aged 65 years or older in the United States is expected to more than double from approximately 46 million people today to more than 98 million people in 2060.

By 2060 one in four Americans will be 65 or older.

“Aging populations clearly place unique and challenging stresses on both the healthcare system, on the social support system, and on… the public financing sector. It’s a challenging demographic change, and it’s important that we plan and prepare and think clearly about what it means for us in the future as well as now,” Mulhausen said.

Dr. Albert Bui, a geriatrician at the David Geffen School of Medicine at the University of California Los Angeles (UCLA) says managing the often numerous health needs of a growing senior population puts strain on the health system.

About 36 percent of the U.S. respondents in the study reported having three or more chronic conditions.

“Part of the pressure on the healthcare system comes from the challenge of managing and treating these competing conditions. A common scenario we see are individuals who are trying to exercise to lose weight but are limited by their age-related osteoarthritis of their joints. More chronic conditions can make life much more complex,” Bui told Healthline.

Despite some of the challenges of an aging population, Mulhausen says there are also positives.

“I think there are wonderful cultural benefits that come from an aging population and the opportunity for intergenerational sharing,” he said.

Mulhausen believes the United States is a wonderful place to grow old but concedes the current approach to caring for elderly people needs some work.

“We need to think hard about how we can rebalance our resources to ensure both the social needs, the long-term service needs, and the healthcare needs of our elderly citizens are all met,” he said.