disparities in healthcare: gender
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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
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