DISPARITIES IN HEALTHCARE:

GENDER

Deepa Patel

Doctor of Pharmacy Candidate, 2012

Mercer COPHS

Presented on July 22, 2011

INTRODUCTION Disparities in healthcare by gender can be

somewhat linked to the greater need for care throughout the lifespan of a female patient when compared to males Females have a greater need for reproductive and

preventative care during their younger yours Females also have a greater need for treatment from

numerous chronic disease states at an older age

Nearly 80% of women have a usual primary care provider, whereas 72% of males do

Females are more likely to be unable to receive or receiveddelayed medical care, dental care, or prescription medications

DISPARITIES IN PATIENT-PHYSICIAN COMMUNICATION BY GENDER

Studies indicate that patients are more receptive to communicating when they are able to relate to the information being presented

Female physicians have demonstrated a greater skill of gathering subjective information from patients

QUALITY OF CLINICAL CARE2010 National Healthcare Quality

and Disparities Report

DIABETES Both genders had decreases in

hospitalizations for lower extremity amputation from 2005 to 2007

Males, however, had twice as many admissions as women for diabetes

END STAGE RENAL DISEASE (ESRD) The number of female adult

hemodialysis patients that were receiving adequate dialysis was higher than that of male adult hemodialysis patients

Males are more likely to be registered on a kidney transplant waiting list

HEART DISEASE Leading cause of death

Females had higher rates of inpatient heart attack mortality than menRate of receipt of a fibrinolytic medication

was higher in males than womenBoth male and female patients with heart

failure were discharged with appropriate medications at a rate of 82%

HIV HIV infection death rate for males was

more than twice that of females (5.4 per 100,000 population versus 2.1)

COLORECTAL CANCER 3rd most common cancer in adults

Rate of advanced stage colorectal cancer in males are significantly higher than women

The rate for both genders, however, is decreasing significantly

RESPIRATORY DISEASES No differences in the treatment of

hospitalized pneumonia patients

Tuberculosis Both genders increased the percentage of

patients who completed therapy Female patients were more likely to complete

treatment when compared to males

Females had lower rates of post operative respiratory failure, sepsis, and deaths following complications of care

MENTAL HEALTH Female patients are 11% more likely to

receive treatment for a major depressive episode compared to male patients

Males had suicide rates four times higher than females

SUBSTANCE ABUSE Females are significantly less likely to

complete substance abuse treatment, 41% compared to 47.1%

SUPPORTIVE & PALLIATIVE CARE Pressure ulcers

Both genders had decreases in short and long term stay incidence of ulcers

Females were less likely to have either type

Female patients were more likely to receive potentially inappropriate medications

FAVORABLE OUTCOMES IN DISEASE STATES BY GENDER

Male Female

Kidney transplant waiting list registration

Inpatient myocardial infarctions

Appropriate medication dispensed

Completion of substance abuse treatment

Diabetes Adequate dialysis in ESRD HIV Colorectal Cancer Tuberculosis Post operative respiratory

failure Sepsis Deaths following

complications of care Major Depressive Disorder Suicide Attempts Pressure Ulcers

DISPARITIES OF ACCESSIBILITY Male patients are more likely to be

uninsured

Many associate the incidence of women having insurance coverage with increased ease of availability of programs such as Medicaid for children and prenatal care

An argument can be formed that increased needs for healthcare in females makes having insurance a greater need than with male patients

HEALTHCARE REFORM March 2010: Two federal statutes

colloquially referred to as “Health care reform” passedPatient Protection and Affordable Care ActHealth Care and Education Reconciliation

Act

One of the main goals is to expand insurance coverage, particularly to low and moderate income and uninsured adults

MASSACHUSETTS ATTEMPTS UNIVERSAL HEALTHCARE In 2006 the state passed its health care

insurance reform law

Parallels goals with National Reform:State regulated minimum healthcare

insurance coverage Free health care for residents below

established income levels even if patient doesn’t qualify for Medicaid

Reduce burden of EMTALA

RESULTS FROM THE HEALTH REFORM IN MASSACHUSETTS “Have Gender Gaps in Insurance Coverage and

Access to Care Narrowed under Health Reform? Findings from Massachusetts.”

Cross sectional study based on surveys

Observed differences pre health care reform (2006) and post reform (2009) in adults by gender Insurance coverage Access to health care Use of healthcare Affordability

2006 FINDINGS: ALL ADULTS

Insurance Coverage

Access (non ER)

Rx Use Unmet needs due

to cost

0

10

20

30

40

50

60

70

80

90

100

WomenMen

2009 FINDINGS: ALL ADULTS

Insurance Coverage

Access (non ER)

Rx Use Unmet needs due

to cost

0

10

20

30

40

50

60

70

80

90

100

WomenMen

2006 FINDINGS: DIFFERENCES IN GENDER BY AGE GROUP

Insurance Coverage

Access (non ER)

Rx Use Umet needs due

to cost

0

2

4

6

8

10

12

14

16

18

20

18-45 y/o46-64 y/o

2009 FINDINGS: DIFFERENCES IN GENDER BY AGE GROUP

Insurance Coverage

Access (non ER)

Rx Use Umet needs due

to cost-5

0

5

10

15

20

18-45 y/o46-64 y/o

CONCLUSIONS Overall, younger and older women

continue to use more care than men under healthcare reform

Despite increases in insurance coverage, women were still more likely to report unmet needs for health care and problems affording care than menEspecially true in younger adults

APPLICABILITY IN NATIONAL REFORM Coverage does not always translate to

access to healthcare and affordability of careParticularly in patients with greater

healthcare needs, such as women of all age groups

Despite mandated healthcare coverage, affordability is a major concern

Preventative care coverage standards vary greatly amongst states