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Health Care Inequalities between Men and Women

 “A Woman is not a pre-existing condition” This is the slogan that can be seen on a shirt worn by a women at a 2009 health care reform campaign. This week’s topic, which I will be discussing, is: Gender and how it relates to a Health Crisis. In the U.S., there is an on-going debate about healthcare inequality between men and women, specifically that men pay less than women do, on average for identical health care plans (basic plans that do not include maternity care).

Insurance agencies claim that women often pay more than men for similar health care plans, because they use their coverage more. As reported in the New York Times article linked below, “Insurers said they charged women more than men because claims showed that women ages 19 to 55 tended to use more health care services. They are more likely to visit doctors, to get regular checkups, to take prescription drugs and to have certain chronic illnesses.” Essentially, women are being penalized for taking care of their health. Women who take these measures and receive regular check-ups are often preventing catastrophic, expensive to treat diseases from developing.

The difference in rates between men and women can not be explained by maternity costs, and if a women chooses to add this to her plan, has to pay another additional (expensive) fee. “According to CNN New research by the National Women’s Law Center released Monday shows that, in states that have not banned gender rating, 92% of the top plans charge women more — despite the fact that the vast majority of them do not cover maternity services.”

Women are not just being charged more than men, they are being charged significantly more. The average woman pays 30% more than a man purchasing an almost identical package. Some states have taken action to ban gender rating, but 90% of the best selling health care plans still charge women more than men.

 

I would like everyone to take a few minutes and read the following articles, as well as share your thoughts to the questions below.

http://edition.cnn.com/2012/03/20/opinion/greenberger-health-premiums-gender-gap/index.html

http://www.nytimes.com/2012/03/19/health/policy/women-still-pay-more-for-health-insurance-data-shows.html?_r=1

 

1.)  Is healthcare inequality between men and women an issue in your country?

2.)  Do you think that there is some legitimacy in women paying more for health care plans?

3.)  Women are often charged 30% more than men for basic health care plans. Although women do utilize the services more, does this warrant such a significant increase in cost?

Can’t wait to hear your thoughts and opinions!

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19 Comments

  1. Alex says:

    This is certainly a topic due for reflection for all U.S. citizens. Unfortunately, the gender issue is not only discrepancy in health insurance. For instance, people can be screened out and refused participation in some insurance plans due to pre-existing conditions, I believe. This may have recently become illegal or is in the process of such – I have not kept up to speed.

    Regarding how health care is used by men and women, it has been proven that men in the U.S. are less likely to go to the doctor on a regular basis and less likely to see preventative medicine. The image that comes to my mind is when I have gone to visit elderly relatives in nursing homes – most of the patients are women, because frankly, the men died sooner.

    There is this billboard I have seen in the Boston area touching on the unwillingness of men to go to the doctor. It says, “This year thousands of men will die from stubbornness.”This ad by the U.S. Department of Health and Human Services is to bring this matter to men’s attention and encourage them to visit doctors for preventative care. See it here:

    On a sociological level, whether men’s unwillingness to visit the doctor is due to society conditioning them to be tough and to push through pain, or if it is due to them simply not being conditioned to be as aware of their bodies and concerned about health issues – I do not know.

    As Meredith noted, women are taking advantage of preventative services. It is reasonable to pose that men not taking advantage of these services may be contributing to more chronic health issues later on.

    Women may be more likely to utilize certain services. However, men should be using them as well. I don’t think this is entirely uncharacteristic of the U.S. individualistic culture, where it’s “us” and “them” instead of balancing the insurance costs out equally. Men have serious health risks as well. The going cancer rates in the U.S. are that 1 in 2 men or and 1 in 3 women will experience cancer in their lifetimes. A family member of mine is a cancer survivor and he received early treatment because the cancer was found during preventative care. However, the exact test that found his prostate cancer is now being threatened to be removed from practice? Why? I do not know the details, but this sends a message that preventative care is not important.

    Cancer rates in the U.S. and in other countries are staggering, and it is worth reflection why some forms of cancer are increasing and others are decreasing. This chart below shows how (in the U.K.) certain forms of cancer in women are decreasing, but certain forms of cancer in men are increasing. Why is this? This is in the U.K., but you get the picture:

    I also recall an ad that is in the MBTA buses. It shows three African American women and says, “One of these women has breast cancer. Do you? Going along the lines of human perception and how they may relate to insurance, this add may be sending a message that breast cancer is very common in women. Comparatively, you will never see similar a similar ad about prostate cancer in men because it is still a taboo topic in the U.S., similar to how breast cancer was years ago.

    My point is that there are deep seeded perceptual issues affecting human behavior which are in turn affecting health and insurance.

    • meredithmckenna says:

      Alex- I love the link the to the billboard that you shared- very clever way to sum up the situation of men’s refusal to take preventative measures with their health.

      You also make a very good point about people being screened for pre-exisiting conditions. I was switching health care policies last summer and had to be screened for a number of conditions- it’s definitely still an issue, and can make it very difficult (and expensive) for a number of people to receive health care.

      I think the last statement that you made, that there are deep seeded perceptual issues affecting human behavior, and that these issues are really taking away from health care is right in point. It’s not the technology or knowledge that is preventing men and women from receiving care, it’s essentially ourselves that are the barrier. Health care is one of the most basic human needs, and the issue should not be as complex as it here in the U.S.

  2. Laura Chechette says:

    1.) Is healthcare inequality between men and women an issue in your country?

    Obviously healthcare inequality is a huge issue in the US. I was happy to learn that MA is one of the 14 states that has policy’s in in place to prevent gender rating in heathcare, but I feel like MA has always been a little ahead of the curve when it comes to healthcare. I feel like so many people are against The Health Care Reform Act (aka “Obama-Care”) just because Obama is involved. If people took the time to understand how the plan would benefit them and others they may be more open to it. See the comic below for an example: http://www.carlsontoons.com/tag/health-care-reform/

    2.) Do you think that there is some legitimacy in women paying more for health care plans?

    No I don’t think there is any legitimacy in women paying more for healthcare and I’m not just saying that because I am a woman. No one chooses their sex at birth. (Maybe some people decide to change their sex later in life, but that is a whole other case I am not going to go into.) You do choose how you live your life however and how well you manage your health. If you smoke, or drink, or do drugs, or part take in other unhealthy activities then yes you should be charged more for healthcare because you made those decisions. I admit that the ability to bear children does mean that women may have more expensive medical procedures at some point, but what if a women never had children? Should she just have to pay more because she has the ability to?

    3.) Women are often charged 30% more than men for basic health care plans. Although women do utilize the services more, does this warrant such a significant increase in cost?

    I don’t believe that because woman take better care of their health they should be punished for it. Women automatically have to use more services to take care of their reproductive, which is not an area that men have to worry about. In the long run preventative care made up of a doctors visit once or twice a year is significantly lower in cost than a trip to the emergency room when someone waits until they are seriously ill. People pay for health insurance so they can use it, not to pay and pay and pay and never get any benefit from it.

    • meredithmckenna says:

      Laura- I think you make a good point in saying that people do not choose their gender at birth, and things like a person’s decision to smoke or do drugs should be a determining factor in the price of health care, and not whether they are male or female. Gender based inequalities in health care have little merit, and people should not be discouraged from trying to take care of themselves in the best way possible.

      I also really like the comic you posted- it’s so true people just hear the word “Obama” in “Obama-Care” and their mind is made up before they have even looked at the details of the plan.

  3. Boon Han says:

    Wow… Meredith is trying to start a gender war here… hahaha…

    Since I am one of the few males in the class, I guess I am obliged to speak from the perspective of the males in order to keep the discussion interesting…

    Objectively speaking, I don’t think insurance companies have a vendetta against women and would discriminate against women simply because they are, well, women. It is true that women as a collective whole, make use of healthcare services more than men. Perhaps it is because of a false sense of masculinity, men would usually not see doctors for minor ailments and will normally only see doctors when it is a last resort. And as a result of this, often lead to their own early demise.

    The reason that women are charged more is probably purely a pragmatic business decision based on actuarial science which takes into account the patterns of use which affect the potential costs involved. It is akin to charging a young inexperienced driver driving a sports car a higher premium for motor insurance. In the world of economics, this is simply known as price discrimination.

    I personally feel that it is more a business decision than a deliberate effort to discriminate against women in general. Price discrimination is a tool used by corporations to set the prices of goods at a level which is acceptable to the different target groups, maximize the sale of the goods and their profits. Logically speaking, if there is no significant difference in costs of providing healthcare to different groups of people, there would not be an impetus to create such distinctions in pricing since it will only result in increased administrative costs for the insurance companies and thus affecting their bottom-line.

    As the price of premiums does affect the decision of consumers to purchase insurance, if the prices are set at a higher level for males, insurance companies stand to lose the business of the many “silly” men who consider themselves tough as an ox and cannot even remember the last time they visited a doctor in the last 10 years. Raising the premiums for men who seldom (or perceive that they seldom) make use of the healthcare system, would simply result in more men who would choose to “take the chance” and forgo health insurance altogether after they do their sums at the back of an envelope and conclude that the premiums aren’t worth it.

    To insurance companies, this may result in less customers for them and less profits. It may even result in a vicious cycle whereby they have to raise the average premiums of remaining customers to account for lesser profits and induce more and more people who are on the fence to decide to forgo health insurance…. and the cycle continues…

    Thus, to insurance companies, it is critical for them to price their products accurately based on accurate data which is well grounded in actuarial science in order to maximize their profits and keep the business sustainable.

    Business sustainability and profitability definitely ranks higher in their consideration when compared to being politically correct. If compelled to be politically correct by law, it may eventually result in the vicious cycle I mentioned earlier where all remaining customers eventually pay higher premiums collectively…

    • meredithmckenna says:

      Boon- hahaha- I was looking forward to a male response to this post!

      It’s true, we live in a capitalistic society, and health care is just another business venture to insurance companies. People are trying to make money, and health care is just another way to do it. It’s unfortunate that women are the ones bearing the brunt of health care costs and are paying significantly more than men.

      I like how you make the point that if insurance premiums were to be raised for men it would just give them another reason to avoid getting themselves a plan. There needs to be some type of intervention to figure out how to persuade men to take health care more seriously, and to not think of receiving health care as being “weak.” If men did start to utilize health care more, the prices between men and women may start to even out. The question of how to get men thinking differently about health care is not something that can be answered over night, but I think we need to take a more aggressive approach towards getting some answers.

      • Boon Han says:

        Meredith, a possible way to even out all the premiums is if Americans are willing to give Obama-care a chance and forgo their choice of “not purchasing healthcare”… If healthcare is made mandatory for everyone, then there is no need for the price differentiation, a simpler formula can be used to distribute the overall costs amongst all working adults…. But I guess the supreme court’s ruling places the preservation of American’s constitutional right to choose to not be covered by insurance above it all….

  4. KSA ROCKS! says:

    Hey,

    I agree with the blog that health care inequalities exist between men and women. According to our biological make up, a woman is more prone to health risks compared to a man. She is different than a man in a number of ways, which includes their ability to fight diseases. Due to hormones, body composition among many other factors a woman is likely to be exposed to many health problems than a man. This clearly shows why this health care inequality exists between the two genders. Therefore a woman will pay more for health care plans than a man. Since men hold the most powerful positions in the society they have used their influence in the society to formulate and implement policies that affects the welfare of women. Gender inequality policies in the health sector have led to health crisis.

    Regarding the legitimacy of women paying more for health care plan, I don’t think there is any legitimacy of women paying more than men. Apart from maternity charges, which do not apply to men, both genders should be charged equal charges since the services provided to them are the same. Men are not special beings than women, thus there is no need of overcharging women. Disparity in the health care sector in the United States and other parts of the world should be eradicated in order to promote gender equality in the society. If women add their maternity costs it is true that they will pay additional fee which will make the situation more worse. Therefore it will be a good thing if health insurers consider women in health insurance.

    The fact that women utilize more health care services does not warrant any significance in increasing the cost of their services. On the other hand the more than 30% women are charged than men for basic health care plans is not realistic. Albeit they utilize the services more, in my opinion this percentage is too high for them. As that is how they were created we don’t have to charge them high costs because they utilize more services. The costs should be slightly higher than for men but not at that extreme. The insurance companies should cut these costs, as we know that women will not survive without these crucial services. They should not also raise the rates for men, as men are not more prone to health risks. If they do this they are going to incur heavy losses as they are going to lose customers. Since the cost for basic health care plans is constant, then both men and women should be charged equally without any disparity. The government and all stakeholders of the health sectors should formulate policies that will solve problem in the quest of eradicate the vice of disparity in the health sector. Women should be given equal opportunity as men in the health sector. If this problem of disparity in the health sector is not resolved, women will continue to suffer and some of them will unable to afford the high cost of basis health plant.

  5. tjglover23 says:

    A part of me agrees with Boon. When you think about it women do use health care services more often than men and we have the ability to have children, which is really expensive. Not only when going into delivery but all of the doctors appointments leading up to birth is expensive. Though it could be reasoned that instead of charging women more than men, the money not used by men could be used on women; that plan is not economic and it doesn’t fall in line with it being a mans world.

    I think that health insurance is only a piece in which America practices discrimination against women and others. There are a lot of battles that must be fought in this war of discrimination and there is a long road ahead. I think that like most things this is going to have to take time and people on a united front knowing exactly what they want. I am glad we are getting the conversation started.

    Women being charged 30% more than men is a bit much. I don’t know the numbers and health care is not the business I am in but I would think that insurance companies could decrease the gap and include maternity care within a basic health plan for women, instead of making it separate.

  6. Ji Li says:

    To be honest, health issue is not a very popular topic among Chinese people,especially among Chinese young people, so I don’t have very rich knowledge about how health issue has been going in China currently and in the past years. From my limited knowledge, I don’t think the health care inequalities between men and women are so obvious in my country. There do exist some inequalities between people from different social classes, which is another issue we have discussed in last blog. As for the inequalities between genders, it is not a big problem as that in the US.

    I don’t think that there is any legitimacy in women paying more for health care plans. From the physiological aspect, women are born to have far more issues to deal with than men, which makes women have to spend more money than men every month, or for example, endure more pain than men when women are pregnant and laboring babies. It is impossible for women to avoid such innate physiological characteristics and women have no other choices but using more services of health care plan. Under such circumstances, it is certainly unfair for women to spend more money than men on health care plans while we already pay more than men for keeping us healthy other than the health care plans.

    My answer for the 3rd question is as similar as I mentioned above. Women use more services of health care plans because of our physiological characteristics that we are born with. That’s not women’s choice but women’s nature which cannot be denied. So the increase in cost is not equal.

  7. Alex- thanks for sharing that billboard. It seems many of us can agree that men use their health services less than women. That said, I’d like to draw a parallel to car insurance. (As far as I know) women are not automatically charged more than men (though many men would argue women do not drive as well). Instead, a person often pays a higher deductible for car insurance the more they use their insurance personally.

    I think that is why the campaign says that “being a woman is not a pre-existing condition.” Many health insurance companies charge people more if they have chronic health issues and pre-existing conditions as they know the person will use their health insurance more (just like a person who uses his/her car insurance more.) Many women are very healthy though and there’s no telling if an individual will use her insurance more just because she is a woman. Surely a lot of women are paying more and they do not even use their insurance.

    I am glad, Meredith, that you brought this up as I didn’t realize this was an issue. I currently get my insurance through my company and have my boyfriend (as a domestic partner) on my health plan. His portion is much higher because my company pays part of my plan and not for any “dependents.” It is also incredibly surprising that this increased rate for women is in addition to maternity coverage. I’ve been talking to several co-workers who were just on or are going to soon be on maternity leave and they couldn’t say enough about how poorly the system was run; how they were entitled to 3 months leave, but only paid for 6 weeks; how their medical bills were still several thousand dollars even with insurance, etc. Word to the wise: save money before having kids!

  8. zhoulinjolin says:

    Like Ji mentioned, this inequality issue is not so obvious in China. For most employees, they can get employer-sponsored health insurance. Usually the insurance is like a credit card, and each employee can get a sum of money every month. When they go to see a doctor, they can just use this card to pay. As far as I know, male and female get the same amount of money. Women usually take more chances to see doctors, so viewed in this light, this is the healthcare inequality in China.

    If take a look at more issues extended from the inequality in healthcare, male usually have more job opportunities than female, especially single females. Because employers believe that single employees will get married, be pregnant and labor children after in several years after they are employed. It takes a woman about one and a half year from being pregnant to take a rest after giving a labor. The recess will affect her company’s productivity. But male can work constantly. This inequality is “everywhere” in China.

    It has been called loudly for many years that the society needs to care women more. Therefore, the society should at least guaranty women’s equality in healthcare.

  9. andreslmc says:

    2)Generally, I think that people who use their health care service more should have to pay more. However, I don’t think that people should have to pay higher premiums based on the projections of health-care coverage cost models or based on one’s gender. Clearly these cost projection models, which in this case use gender as a benchmark, are designed to minimize coverage costs for health-care insurance companies. In this case the cost projection models indicate that a health insurance company can be more profitable by charging higher premiums to those individuals that the health-care cost models deem to be more expensive to cover. Clearly, as reported by CNN and the NY Times, these health-care coverage cost models are discriminating people based on their gender.

    I don’t think that women should have to pay more for health care plan because of their gender. Governments must take action in order to stop this discrimination from occurring. This topic certainly brings to the fore the debate Americans have been having about what role government should play in the health care sector.

    3) If an individual is using a health care service that is 30% more expensive, then yes, I think this person should in theory pay a price for health care coverage that is 30% more expensive. However, I don’t think these additional costs for service should be included in the health care premium. I think that people should pay for the service that they use and not the service that they are projected to use.

    • Boon Han says:

      Hi Andres, I don’t quite agree with what you said in point 3 because I don’t think that is how insurance works.
      The whole purpose of insurance is simply to spread out the individual financial risks amongst the collective whole. Thus, there will always be certain sectors which are subsidizing others.
      The irony of purchasing motor insurance is that we pay the premiums but we never ever wish that we get into a car accident so that we can make a claim and get our “premium’s worth” right? We are simply paying a premium for the assurance that if we do in fact get into a serious accident or something, we would not be faced with financial doom, and the injured can be compensated even if the perpetrator is dead broke because the money comes from the insurance company.
      There will always be an old granddad out there who has paid motor premiums for the past 30 years without making a single claim and a young punk who get into serious accidents the second day after buying a car…
      Healthcare insurance would be a little more complicated with more factors to consider but the basic premise of insurance is that it cannot be based on actual usage… If it is, then we might as well not buy any insurance and pay our individual healthcare bills as they are charged….

  10. sonigreca says:

    1.) Is healthcare inequality between men and women an issue in your country?
    I don’t think there is really a issue of healthcare inequality between men and women in China. In stead, the healthcare inequality between the poor and the rich is more obvious.
    2.) Do you think that there is some legitimacy in women paying more for health care plans?
    There is a huge difference of healthcare between China and the U.S. I don’t know about the U.S. But in China, because the inequality between men and women is not a issue, I don’t think it’s necessary to have some legitimacy…
    3.) Women are often charged 30% more than men for basic health care plans. Although women do utilize the services more, does this warrant such a significant increase in cost?
    I understand that women may need different healthcare services from men. But 30% more is not fair for women. So, I don’t think that’s warrant a significant increase on cost…

  11. lisamedina says:

    Interesting topic Meredith! I’m glad Massachusetts in one of the 14 states that prevent gender discrimination, because I’ve been living in ignorant bliss! I had no idea there was issue with inequality in the costs of healthcare.

    I’d have to agree with Boon and Taja – that I don’t think insurance companies are discriminating against women, but predicting patterns of healthcare usage. Unfortunately, it is not very plausible for insurance companies to develop plans based on individual health behaviors. These health behaviors would have to be self reported (i.e. if they are a smoker, chronic disease history, etc.) and if reporting a “negative” health behavior means a higher premium – why would anyone be honest? It is in the best interest of insurance companies to generalize the healthcare statistics and streamline cost across the board (or in this case gender). While on an individual basis women may not be susceptible to certain diseases or health care costs, as a collective in general women’s healthcare costs are much higher and that’s not going to change anytime soon.

    On another note, I’m always a little skeptical of statistics, so I wonder where these comparisons are being drawn from. Are the healthcare costs being compared within 1 insurance company? 1 employer? Probably not. How can we compare the costs from different insurance companies when coverage is represented so difference across each plan and from each provider. It would be interesting to see the comparisons within 1 provider/1 company. To me that would be a better representation of whether or not there is gender inequality in healthcare costs.

  12. Kristina Coppola says:

    I agree that health insurance costs shouldn’t be dictated by gender. However, for many people who have their insurance through their employer, they may never feel the difference in cost at all…the employer simply sets the employee contribution for the available insurance plans and # of people to be covered under your policy, regardless of the gender of the employee, partner, or dependents. I think this goes back to the whole premise that the pricing models are truly based on usage and not on any malicious discrimination.

    On a different note, the whole trend to charge people who are smokers or obese an increased premium because of their increased usage has proved rather controversial here in the States…do you guys see any connection to the reaction of the American public to these stories and that of increased premiums for female subscribers?

  13. grabernieto says:

    I think issues of health insurance in Ecuador are a matter of social and economic inequality and not gender related. Hospitals work there in a way that if you can afford it, you will be able to get the best service, if you not you are left with government services that often times is life threatening. So the issue of insurance in Ecuador is more of a matter of bridging the gap between those who have and those who not. Men and women are equally at risk to that reality. What I do notice, is that there are more services aimed at women in terms of charities and free services for poverty stricken women. Specially in maternity services, my mother actually volunteers at one of these sites, and they help lower income women with all the maternity related services.
    Speaking of maternity, I do believe the reason why women are charge more for insurance in the US is because of child bearing. It makes sense that because women get pregnant and might risks with pregnancy that insurance companies view them as having higher risk in their health, just an example I thought off. I don’t think there should be differences in the insurance charges, women statistically outlive men so it does not make sense that they are charged more than men. I think instead of charging them extra, companies should provide equal insurance and stronger coverage to all. Just my thought 🙂

  14. meredithmckenna says:

    Hi everyone,

    Thanks for all the comments and the unique insights. I enjoyed reading all the
    comments and learning what everyone thought about the issue.

    Based on the comments it seems that in other countries (well..China and Ecuador 🙂 ), gender is not as much of an issue in relation to health care as the inequalities between the rich and the poor.

    Regarding views on inequalities between men and women in the U.S. I think we are a little divided as to whether or not men and women should pay the same for health care plans. It was brought up that maternity care should play into women paying more than men. I do agree that if women are looking to purchase a plan that includes maternity care they should have to pay more, but women are paying more than men for plans that do not include maternity care, I do not think that this makes sense.

    I was also a little skeptical of the statistics too, but I think this link explains the statistics and who conducted the research (The National Women’s Law Center) in greater detail (I probably should have included this to begin with). I think it would be very beneficial for everyone to view this:

    http://www.nwlc.org/sites/default/files/pdfs/nwlc_2012_turningtofairness_report.pdf

    Hopefully we will be looking forward to some nation-wide reform in the near future.

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