Disparities in healthcare: Gender

1. Disparities in healthcare: Gender Deepa Patel Doctor of Pharmacy Candidate, 2012 Mercer COPHS Presented on July 22, 2011

2. 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

3. 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

4. 2010 National Healthcare Quality and Disparities Report Quality of clinical care

5. 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

6. 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

7. Heart Disease • Leading cause of death • Females had higher rates of inpatient heart attack mortality than men • Rate of receipt of a fibrinolytic medication was higher in males than women • Both male and female patients with heart failure were discharged with appropriate medications at a rate of 82%

8. HIV • HIV infection death rate for males was more than twice that of females • (5.4 per 100,000 population versus 2.1)

9. 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

10. 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

11. 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

12. Substance abuse • Females are significantly less likely to complete substance abuse treatment, 41% compared to 47.1%

13. 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

14. Favorable outcomes in disease states by gender • 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 Male Female

15. 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

16. healthcare reform • March 2010: Two federal statutes colloquially referred to as “Health care reform” passed • Patient Protection and Affordable Care Act • Health Care and Education Reconciliation Act • One of the main goals is to expand insurance coverage, particularly to low and moderate income and uninsured adults

17. 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

18. 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

19. 2006 findings: ALL ADULTs

20. 2009 findings: ALL ADULTs

21. 2006 Findings: Differences in gender BY age group

22. 2009 Findings: Differences in gender BY age group

23. 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 men • Especially true in younger adults

24. Applicability in national reform • Coverage does not always translate to access to healthcare and affordability of care • Particularly 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