NSW has been ranked the worst for healthcare affordability among older patients in the latest survey that pits Australia's most populous state against international health systems.
The results released on Thursday showed a larger proportion of NSW patients 65 and older struggled with their medical costs than their counterparts in Australia overall and 10 other OECD countries.
NSW fared worst when it came to the percentage of respondent who said they had problems paying their medical bills (15 per cent), compared to just 1 per cent in Sweden and 10 per cent in the US, found the survey of 24,000 people including 1175 in NSW.
More than one in five (22 per cent) reported spending $1000 or more in out-of-pocket healthcare costs, the third largest proportion after Switzerland (53 per cent) and the US (37 per cent), and well behind the top performer France (3 per cent), according to the the 2017 Commonwealth Fund International Health survey findings released by the Bureau of Health Information (BHI).
Over 20 per cent of older people in NSW said they had skipped a dentist visit when they needed it due to the cost, tying with the US for the poorest result after Australia (23 per cent).
A total of 14 per cent of NSW respondents said they had skipped prescriptions, consultations or treatments due to cost in the previous year, the second lowest score after the US.
One in four NSW respondents said they found it "very difficult" to access medical care after hours without going to a hospital emergency department, trailing the US and seven other countries.
Overall, 71 per cent of NSW respondents said they were either completely or very satisfied with their healthcare, though this was the third worst result among comparators and 13 percentage points behind the best performer, Switzerland.
The survey sample excluded people living in nursing homes.
BHI acting chief executive Kim Sutherland said NSW and Australia had consistently recorded high out-of-pocket costs compared to other jurisdictions.
Federal Health Minister Greg Hunt recently announced an expert committee would investigate bill-shock and exorbitant medical costs as a matter of "considerable community concern".
Healthcare gap for sickest in NSW
The survey also exposed a yawning disparity between the experiences of the state's sickest and healthiest older patients.
Fewer than 58 per cent of "high needs" patients (people with three or more health conditions) said they were very or completely satisfied with their care in the previous year, compared to 81 per cent among patients not classified as high needs. The 22 per cent gap was the biggest among all jurisdictions surveyed.
One thirdof high needs patients skipped a dental visit due to costs in NSW compared to 13 per cent of their healthier counterparts, and more than one in five high needs patients skipped a consultation, test or treatment due to cost compared to fewer than one in 10 people without high needs.
NSW also had the highest rates of psychological distress, yet one of the lowest rates of accessing professional psychological help.
Interestingly, more than half of NSW respondents who said they experienced emotional distress or anxiety said they did not want to see a professional.
Dr Sutherland said the results suggested a reticence among Australians to seek help for mental health problems
"It could also reflect their past experience with healthcare providers and how engaged they are with patients who ask for help," she said.
NSW bests counterparts for care co-ordination
NSW was the best performer when it came to co-ordinating care between services. Just 8 per cent felt their GP was not up-to-date with their specialist care, one of the best results among comparator countries, with Germany bottoming out with 22 per cent.
The federal and state government focus on linking services was an acknowledgement of Australia's "complex health system" that relied on a range of funding models and providers straddling federal and state jurisdictions, as well as private and not-for-profit sectors, Dr Sutherland said.
NSW also had the most encouraging results for follow-up care, with 92 per cent reporting arrangements were in place after they were discharged from hospital, and 89 per cent of people with a chronic condition said they had a treatment plan.
NSW also out-performed comparators for avoiding unnecessary visits to an emergency department, with just 17 per cent saying the last time they visited an emergency department, it was for a condition that they thought could have been treated at their GP clinic.
Australian Medical Association NSW president Brad Frankum said while public hospital care was free, the survey confirmed that out-of-pocket costs could be a significant burden for older people, many of whom were no longer working.
Though the survey assessed patients' perception rather than the actual quality of care, it was clear that for many people, the state's health system was difficult to navigate, Dr Frankum said.
In December NSW Health released the NSW Older People's Mental Health Service Plan 2017-2027 to promote better healthcare access and coordination and has invested $7.4 million to increases access tyo specialist mental health services for older people.
Older people were also a priority of the Oral Health 2020 and the National Oral Health Plan, a NSW Health spokesperson said in a statement.