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Women's Health USA 2004
Health Resources and Services Administration
U.S. Department of Health and Human Services
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Women's Health USA 2004Health Resources and Services Administration |
Table of Contents | Preface | Introduction | Chapter 1 | Chapter 2 | Chapter 3 | Indicators in Previous Editions | References | Contributors
In this chapter:
Usual Source of Care | Health
Insurance | Quality
of Women's Health Care | Medicare and Medicaid | Preventive
Care | Complementary and Alternative Medicine
Use | HIV Testing | Medication
Use and Hormone Therapy | Dental
Care | Hospitalizations | Organ
Donation | Mental Health Care Utilization | Women
in NIH-Funded Clinical Research | Health Care Expenditures
Availability and access to quality health services directly affects the health of women. For women with disabilities, poor health status, poverty, or lack of insurance, access to a range of health services, preventive treatments, and rehabilitation can be critical to preventing disease and promoting quality of life. The following section presents data on women’s health services utilization, including indicators on insurance, usual source of care, health care financing and expenditures, medication use, and use of preventive, dental, hospital, and mental health services.
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Women who have a usual source of care (a place they usually go when they are sick) are more likely to receive preventive care,1, 2 to have access to care (as indicated by use of a physician or emergency room, or not delaying seeking care when needed),3 to receive continuous care, and to have lower rates of hospitalization and lower health care costs.4 In 2002, the percentage of women reporting a usual source of care rose with age, to a high of 96.2 percent among women aged 65 and older. Usual sources of care varied among racial and ethnic groups, with Hispanic women the most likely to report having no usual source of care (20.9 percent), more than twice that reported by non-Hispanic White women. Non-Hispanic Black women were the most likely to report their usual source of care as hospital outpatient clinics (3.0 percent) and emergency departments (2.1 percent) compared to other racial and ethnic groups.
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People who are uninsured are less likely than those with health insurance to seek preventive care, which can result in poor health outcomes and increased health care costs. In 2002, 43.5 million people in the U.S., just over 15 percent of the population, were uninsured. The percentage of people who are uninsured varies considerably across a number of categories including sex, age, race/ethnicity, income, and education. The percentage of females without insurance (13.9 percent) is slightly lower than the percentage of males (16.7 percent). However, non-White women are considerably more likely than White women to lack health coverage: 9.8 percent of non-Hispanic White females are uninsured, compared to 17.9 percent of Black females, 18.0 percent of Asian/Pacific Islander females, and 29.5 percent of Hispanic females.
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The percentage of people without insurance also varies greatly by age. Young adults of both sexes are the most likely to be uninsured: 29.6 percent of 18- to 24-year-olds lack health insurance, as do 24.9 percent of 25- to 34-year-olds. In contrast, because of the Medicare program, fewer than 1 percent of women aged 65 years and older are uninsured. Rates of uninsurance decrease steadily as household income increases, ranging from a high of 23.5 percent for those with incomes below $25,000 to a low of 8.2 percent for those with incomes of $75,000 or more. Insurance rates rise with increasing levels of education as well, as 28 percent of those without a high school diploma are uninsured, compared to 8.4 percent of those with a bachelor’s degree or higher.
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Measuring the quality of health care can provide important information about the effectiveness, safety, timeliness, and patient centeredness of women’s health services.
Indicators used to monitor women’s heath care in managed care plans include: the timeliness of prenatal care, receipt of postpartum checkups after delivery, screening for chlamydia, screening for cervical cancer, and receipt of mammograms. The accessibility of most of these services is increasing.
Men and women fare approximately equally in the safety of their medical care, with a few exceptions. For example, men suffered from accidental lacerations or punctures during surgical procedures at a rate of 3.3 incidents per 1,000 discharges, while women had a rate of 4.2.5
About 21 percent of both men and women report that they are not satisfied with the quality of care they receive from their provider, but almost 32 percent of women, compared to 28 percent of men, report that their providers do not spend as much time with them as they would like.6
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Medicare is the Nation’s health insurance program for people aged 65 and older, some people under age 65 with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant). The Medicare program comprises two parts: Part A, which covers hospital, skilled nursing, home health and hospice care, and Part B, which covers physician services, out-patient hospital services, and durable medical equipment. Among the preventive services covered by Medicare are an annual mammogram, Pap smear, bone density scan, and influenza vaccination.
In 2002, Medicare had over 40 million enrollees, of whom 57 percent were female. The large majority of all Medicare enrollees were aged 65 or older, with the elderly representing 89 percent of female enrollees and 82 percent of males.
Medicaid is jointly funded by the Federal and State governments and provides coverage for low-income individuals and people with disabilities. In 2000, Medicaid covered nearly 45 million individuals, including children; the aged, blind, and disabled; and people who are eligible for cash assistance programs. Sixty percent of Medicaid recipients were female. Fifty-five percent were under age 21, 34 percent were between the ages of 21 and 64 years, and 11 percent were aged 65 years and older.7
Through counseling, education, and screening, healthy behaviors may be promoted in order to prevent the occurrence or reduce the burden of many serious health conditions. In 2001, females made over 520 million physician office visits compared to 360 million made by males. Of visits made by females, 18.5 percent were for preventive care, including prenatal care, general medical examinations, well-baby examinations, and screenings. Various forms of counseling and education occurred during office visits among females and were most commonly related to diet (11.3 percent), exercise (7.8 percent), mental health/stress management (4.0 percent) and/or growth and development (3.3 percent).
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In 2003, the U.S. Preventive Task Force revised their recommendations for screening for cervical cancer; Pap smears should begin three years after the initiation of sexual activity, or at the age of 21, whichever comes first. The Task Force also recommends that women aged 40 and older have a mammogram every 1 to 2 years to detect breast cancer. In 2001, of all office visits among females aged 18 and older, 7.1 percent included a Pap smear. Among office visits by women aged 40 or older, 5.0 percent included mammograms. Rates of Pap smears and mammograms during office visits were similar across racial and ethnic groups.
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Complementary and alternative medicine (CAM) describes a range of health care practices, therapies, and products that are not considered to be part of conventional medicine. Consumers report using CAM for a variety of reasons, including health promotion, disease prevention, and treatment of specific conditions and illnesses.8 In 2002, the CAM therapy most commonly reported by women was prayer for one’s own health (59.7 percent). Women aged 45-64 years old were most likely to report natural herb use, chiropractic care, deep breathing exercises, massage, progressive relaxation, and acupuncture. Women aged 18-44 years were most likely to report having practiced yoga (12.4 percent).
The rates of CAM therapies used varied by race and ethnicity. Non-Hispanic Black women were most likely to report having ever prayed for their own health (76.6 percent). Asian women reported the highest rates of natural herb use (37.1 percent), yoga (16.3 percent), acupuncture (11.3 percent) and homeopathic treatments (5.3 percent). Non-Hispanic White women reported the highest rates of chiropractic care (24.0 percent), deep breathing exercises (19.4 percent), and massage (12.9 percent).
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Today, people aware of their human immunodeficiency virus (HIV) status may be able to live longer and healthier lives, because of newly available and effective treatments. Testing for HIV, the virus that causes AIDS, is an essential step before infected individuals can seek needed care, and is often offered through confidential and/or anonymous sources.
As of 2002, 68.2 million adults reported ever having been tested for HIV, including 30.1 million men and 38.1 million women. The highest percentage of persons that reported ever being tested was among women aged 25 to 34. A higher percentage of women under the age of 45 years reported having been tested than men. For 45- to 64-year-olds, similar rates of testing were reported among both men and women. After age 65 years, the trend reversed, with more men reporting HIV testing than women.
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Among women, non-Hispanic Black women had the highest rate of HIV testing (54.8 percent) followed by Hispanic women (43.2 percent), non-Hispanic women of other races (40.7 percent), and non-Hispanic White women (32.9 percent).
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In 2001, women were more likely than men to discuss medications at physician visits (150.9 and 146.7 mentions per 100 visits, respectively). Specifically, mentions of medication for female patients exceeded males for hormone therapy (19.6 compared to 11.2 mentions per 100 visits, respectively) and central nervous system drugs (14.8 and 10.3 mentions per 100 visits, respectively), which include sedatives, anti-anxiety drugs, and anti-depressants.
The use of medications also increases with age. Medications were mentioned in physician’s offices 97.7 times per 100 visits among females aged 15-24 years, compared to 206.3 times per 100 visits among women aged 75 years and older. This pattern was seen for all medication types with the exception of respiratory tract drugs (26.1 mentions per 100 visits) and central nervous system drugs (17.0 mentions per 100 visits), which were most commonly mentioned during visits by younger women.
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Hormone therapy is one category of drug for which the number of prescriptions has changed significantly in recent years. In July 2002, findings from two studies, the Heart and Estrogen/Progestin Replacement Study follow-up (HERS II) and the estrogen plus progestin trial of the Women’s Health Initiative (WHI), were released which indicated that oral estrogen/progestin hormone therapy may adversely affect the health of postmenopausal women. The studies demonstrated that oral estrogen/progestin does not offer a cardiovascular disease benefit, as was previously believed. Instead, this hormone combination therapy slightly increased the risk of breast cancer and cardiovascular disease in postmenopausal women.9
Researchers tracked hormone therapy prescriptions before and after the study results were released. Between 2002 and 2003, prescriptions fell 66 percent for oral estrogen and 33 percent for oral estrogen/progestin. The total number of hormone therapy prescriptions fell from a high of 91 million in 2001 to 56.9 million in 2003.
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Visiting a dentist regularly is important to achieving and maintaining good oral health. In 2002, although most women (64.8 percent) reported visiting the dentist within the past year, 12 percent had either never seen a dentist or had not seen one within the past 5 years. Frequency of dental visits also varied by race and ethnicity. Non-Hispanic Black women were least likely to report having visited a dentist within the last year (53.2 percent), as compared to non-Hispanic white women (68.4 percent), Hispanic women (54.6 percent), and non-Hispanic women of other races (61.2 percent).
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Income was associated with the length of time since last dental visit. The percentage of women below the Federal poverty level who reported not having visited a dentist within the past 5 years (24.0 percent) was almost five times higher than women with incomes of 300 percent or more of the poverty level (5.1 percent). With increasing income, the percentage of women receiving dental care within the past year steadily increased from 44.0 percent among women with incomes below 100 percent of the Federal poverty level to 77.4 percent among women with incomes of 300 percent of the Federal poverty level or more.
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Females represented 60.6 percent of the nearly 32.7 million short-stay hospital discharges in 2001. Of all female discharges, 38.2 percent occurred among women aged 15-44 years, due in part to hospitalizations for childbirth. Nearly one-fifth of female discharges were for childbirth, and one-quarter of all procedures performed on females were obstetrical in nature. Other diagnoses common among females were diseases of the circulatory system (16 percent of female discharges), and diseases of the respiratory system (9 percent of female discharges).
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Overall, females had a much higher hospital discharge rate than males (1,367.3 versus 925.9 per 10,000 population). Differences existed between males and females in the discharge rate for every category of primary diagnosis. Women had a much higher rate of discharges with the primary diagnosis of genitourinary system diseases, such as kidney diseases (85.8 versus 39.4 per 10,000 population), and neoplasms (71.1 versus 44.2 per 10,000 population). The only primary diagnoses for which men had a higher discharge rate were diseases of the circulatory system (220.3 versus 218.8 per 10,000 population) and mental disorders (86.8 versus 79.7 per 10,000 population).
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During 2003, there were more than 24,000 organ transplants in the U.S., but more than 80,000 people were waiting for organs. Females make up 38.5 percent of those receiving transplants and 42.5 percent of those on the waiting list. Racial and ethnic minorities are disproportionately represented among women waiting for an organ: 28.3 percent of women on waiting lists are non-Hispanic Blacks and 15.0 percent are Hispanics. A large disparity exists between the number of organ donors and the number on the waiting list for an organ. The gender distribution among organ donors was fairly even, with males representing 50.7 percent and females representing 49.3 percent of donors, although women are more likely to be living donors (58.4 percent) compared to men (41.6 percent).
The kidney was the organ in highest demand, with a total of 55,079 individuals awaiting a kidney. Of these, 23,384 were female and 31,695 were male. The number of females on the waiting list for a kidney was nearly four times higher than the numbers of female kidney donors (6,047). Typically, female transplant candidates are able to receive organ donations from either males or females. Only in the case of heart, lung, and liver transplants is the size of the organ a consideration. In the case of these organs, a female transplant patient is better suited to receive an organ from another female.
Obtaining consent for organ donation has been challenging. Some of the reasons consent rates vary include religious beliefs, poor communication between grieving families and health care providers, perceived inequities in the allocation system, and lack of knowledge of the wishes of the deceased. Ethnicity may also affect willingness to consent to donation.10
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In 2002, an estimated 27.3 million U.S. adults reported receiving mental health treatment in the past year. Women represented two-thirds of users of mental health services. The most common type of treatment among adults aged 18 years and older was prescription medication, followed by outpatient treatment. Over 15 million women and 6.7 million men used prescription medication for treatment of a mental or emotional condition. Inpatient treatment was the least utilized treatment by adults aged 18 years and older, and was used by both men and women in approximately equal numbers. However, it should be noted that if inpatient treatment for alcohol and drug abuse were included here, men would far outnumber women.
Mental health services are needed, but not received, by millions of adults in the U.S. Among adults with serious mental illness in 2002, 30.5 percent reported an unmet need for treatment or counseling for problems with emotions, nerves, or mental health. Cost was the reason most often cited for not receiving needed mental health treatment.11
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Of the approximately nine million human subjects in clinical research funded by the National Institutes of Health (NIH) in Fiscal Year 2001, about two-thirds were women. Women also constituted about two-thirds of Phase III clinical research participants. Phase III clinical investigations usually involve several hundred or more human subjects for the purpose of evaluating an experimental intervention in comparison with a standard or control intervention or comparing two or more existing treatments. When sex-specific studies are excluded, the proportions of women and men participating in NIH funded clinical studies were more closely representative of the general population: 44.4 percent women and 55.2 percent men.12 When assessing inclusion data, enrollment figures should not be directly compared to the national census figures.
The numbers of women and/or minorities included in a particular study depends upon the scientific question addressed in that specific study and the prevalence among women, men and minority populations of the disease, disorder, or condition under investigation. Therefore, these data should not be compared to the census figures for the general population.
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In 2000, the majority of both women’s and men’s health care expenses were covered by public or private insurance. For women, approximately one-third of expenses were covered by either Medicare or Medicaid, while just over 40 percent of expenses were covered by private insurance. Although the percent of expenditures paid by private insurance were approximately equal for women and men, women’s health care costs were more likely than men’s to be paid by Medicaid or out of pocket.
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Among those who had a health care expenditure in 2000, the average per-person expenditure for females was higher than for males ($2,757 compared to $2,633). This gap has narrowed since 1998, as the average expenditure for males increased more steeply than the average for females. This increase was particularly evident in hospital inpatient services, which men’s average expenses increased by $3,750 while women’s decreased by $1,715. However, women’s average health care expenses continue to exceed those for men in several categories, including home health services, office-based medical provider services, prescription medications, and dental services.
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Table of Contents | Preface | Introduction | Chapter 1 | Chapter 2 | Chapter 3 | Indicators in Previous Editions | References | Contributors