Health Care Costs and Access to Care - Women's Health Highlights: Recent Findings (continued)

Health Care Costs and Access to Care
Many changes have taken place over the last 20 years in health care delivery and how we pay for care in the United States. The cost of care has continued its upward climb, which has been particularly steep in the last 5 to 10 years. In 2006, an estimated $1.03 trillion was paid for hospital inpatient and outpatient care, emergency room services, office-based medical provider services, dental services, home health care, prescription medicines, and other medical services and equipment for nearly 3 million individuals in the United States. In 1997, total health care expenditures were $553.2 billion; this number increased to $1 trillion in 2006.

Access to care continues to be a problem for many Americans, including women, and access is a particular challenge for those who lack health insurance, either private insurance or public coverage. For example, in 2006, about 68 million people under age 65—or nearly 27 percent of the population—were uninsured at some point during the year.

Costs
•Women who receive food stamps spend more on health care and are more likely to be overweight or obese.
Researchers analyzed State-level data on food stamp program (FSP) characteristics and Medical Expenditure Panel Survey data to estimate the link between FSP participation and weight and health care expenditures of nonelderly adults. They found that women who receive food stamps are nearly 6 percent less likely to be normal weight and nearly 7 percent more likely to be obese as women who do not receive food stamps. Also, participation in the FSP leads women to devote $94 extra per year to health care. Meyerhoefer and Pylypchuk, Am J Agric Econ 90(2):287-305, 2008 (AHRQ Publication No. 08-R072)* (Intramural).

•The health costs of being a woman are substantial.
Based on 3 years of data from the 2000-2002 Medical Expenditure Panel Survey, more than one-fifth of women (21.2 percent) sought care for a female-specific condition over a 1-year period, primarily gynecologic disorders, pregnancy-related conditions, and menopausal symptoms. Women's health care costs were substantial. For example, women spent from a mean of $483 per year for menopausal disorders to $3,896 for female cancers. Overall, women spent an estimated $108 billion a year for health care, of which more than 40 percent was for female-specific conditions. Kjerulff, Frick, Rhoades, and Hollenbeck, Women's Health Issues 17:13-21, 2007 (AHRQ Publication No. 07-R057)* (Intramural).

•Researchers examine women's health care costs and use of services.
This comprehensive review of U.S. women's health care use and expenditures shows that in 2000, 91 percent of adult women used some form of health care services. Overall, 82 percent of adult women had an outpatient care visit, and 11 percent were hospitalized. The mean expense per woman was more than $3,200 in 2000. Women with private insurance and those on Medicaid were more likely to use health services than uninsured women, and white women used any type of health service more often and used more prescription drugs than minority women and men. Nearly 30 percent of older women in fair or poor health spent 10 percent or more of their income for out-of-pocket medical care in 2000. Taylor, Larson, and Correa-de- Araujo, Women's Health Issues 16(2):66-79, 2006 (AHRQ Publication No. 06-R044)* (Intramural).

Access to Care
•Women are vulnerable to coverage and care gaps when their husbands transition to Medicare.
Some near-elderly women (aged 62 to 64) experience disruptions in their insurance coverage as their husbands turn 65 and transition to Medicare, according to this study. Women whose coverage was interrupted had a 71 percent increased probability of changing their normal care provider or clinic, and they were much more likely to delay filling a prescription or take less medication than prescribed because of cost. Many women in this age group have one or more chronic conditions, and disjointed care could lead to adverse consequences in this group. Schumacher, Smith, Liou, and Pandhi, Health Serv Res 44(3):946-964, 2009 (AHRQ grant T32 HS00083).

•Women accounted for nearly 60 percent of hospitalizations in 2007.
Almost 25 percent of the 23.2 million hospital admissions of women in 2007 were for pregnancy and childbirth, and nearly 10 percent were related to cardiovascular disease—the number one killer of women. Other leading causes of hospitalization that year included pneumonia, osteoarthritis, depression and bipolar disorder, and urinary tract infection. HCUP Facts and Figures, 2007. More information is available at http://www.hcup-us.ahrq.gov/reports/factsandfigures/2007/TOC_2007.jsp (Intramural).

•Problems in accessing care are common among women with disabilities.
About 16 percent of adult women have at least one functional limitation (e.g., difficulty lifting 10 pounds, standing for 20 minutes, using fingers to grasp something, etc.); those with three or more functional limitations are more likely than other women to report being unable to get medical and dental care, according to this study. Women with functional limitations who were age 65 or older were less likely to receive Pap tests or mammograms, compared with women who had no functional limitations. They also were more likely to report being unable to get prescription medicines or eyeglasses, regardless of age group. Researchers compared demographic characteristics, reported health measures, use of clinical preventive services, and other factors. Chevarley, Thierry, Gill, et al., Women's Health Issues 16:297-312, 2006 (AHRQ Publication No. 07-R037)* (Intramural).

•Study characterizes women's preventive health care visits.
Researchers analyzed data and interview notes on 95 visits with adult females who saw 47 different clinicians at 18 Midwestern family practices. They found that the preventive services delivered in more than half of visits included blood pressure measurement, weight assessment, breast and pelvic exams, identification of smoking status and related counseling, and mammography recommendations. Key issues addressed less often included cholesterol screening, colon cancer screening, alcohol use, and recommended immunizations. Clinicians were inconsistent in obesity counseling. Backer, Gregory, Jaen, and Crabtree, Fam Med 38(5):355-360, 2006 (AHRQ grant HS08776).

•Women living in rural areas receive less preventive care than those residing in urban areas.
Researchers examined differences in use of preventive health services in four types of counties: large metropolitan counties, small metropolitan counties, counties adjacent to metropolitan areas, and rural counties (not adjacent to metropolitan counties or with fewer than 10,000 residents). They found that rural women were less likely than urban women to have had cholesterol tests, dental exams, and mammograms during the previous 2 years, but they were more likely to have had their blood pressure checked during the previous year. Rural residents, on average, had lower incomes and less education than their urban counterparts, and they were more likely to be uninsured and to face structural barriers to care, such as long travel times, than those living in urban areas. Larson and Correa-de-Araujo, Women's Health Issues 16(2):80-88, 2006 (AHRQ Publication No. 06-R045)* (Intramural).

•Clinic-and community-based strategies can promote use of preventive care by Latinas.
This study found that using promotoras—lay health advisors recruited from the community—and professional interpreters could increase the use of preventive services among Hispanic women and their children. Other strategies for promoting preventive care among Latinas included tagging the charts of at-risk patients, using videos for in-clinic education, and asking patients for updated contact information at each clinic visit to facilitate recall/reminder interventions. Wasserman, Bender, and Lee, Med Care Res Rev 64(1):4-45, 2007 (AHRQ grant HS13864).

•Certain aspects of medical care are critically important to female Somali refugees newly arrived in the United States.
In-depth interviews with resettled Somali women in Rochester, NY, revealed differences in spoken language, degree of acculturation, and literacy. They described the elements of U.S. primary care most important to them, including ease of accessing the health care system, availability of interpreters, a trusting relationship with clinicians, and the availability of female clinicians, especially for gynecologic exams. Carroll, Epstein, Fiscella, et al., Patient Educ Counsel 66:337-345, 2007 (AHRQ grant HS14105).



Health Care Quality and Safety
Finding ways to improve health care quality and enhance patient safety has become one of the most significant challenges facing the American health care system. AHRQ researchers are seeking answers and developing tools to improve the quality and safety of health care for all Americans, including women.

•Case study sets the stage for a discussion of error disclosure in U.S. hospitals.
A case of wrong-site surgery for skin cancer serves as a framework for discussion of medical error and its disclosure to the patient by the surgeon and the hospital. The author reviews the state of error disclosure in U.S. hospitals, summarizes the barriers to disclosure and some possible solutions, and discusses recent developments in disclosure undertaken by Federal agencies, universities, and national quality organizations. Gallagher, Acad Med 84(8):1135-1143, 2009 (AHRQ grant HS16097).

•Use of electronic health records in labor and delivery units can improve the quality and safety of care.
Researchers examined 250 paper-based and 250 electronic health record (EHR) labor and delivery notes in a busy university hospital labor and delivery unit. They found that the paper-based notes were substantially more likely to be missing key clinical information compared with the EHR. Information most likely to be missing included data on contractions (10 percent for paper vs. 2 percent for EHR), membrane status (64 vs. 5 percent), bleeding (35 vs. 2 percent), and fetal movement (20 vs. 3 percent). When workflow was examined, both computer-related and direct patient care activities increased significantly after EHR implementation. Eden, Messina, Li, et al., Am J Obstet Gynecol 199:307.e1-307.e9, 2008 (AHRQ grant HS15321).

•Study examines male-female disparities in risk for workplace injury.
In this study of male-female and racial disparities in individual workplace injury and illness risk over time, white men had the highest risk of injury relative to other groups. But, among women, black women had the highest risk of injury. Environmental hazards were associated with elevated injury risk, but no association was found between the level of physical demand and risk of physical injury. Berdahl, Am J Public Health (12):2258-2263, 2008 (AHRQ Publication No. 09-R020)* (Intramural).

•Content of physician visits differs for women and men.
This study found that the content of women's visits to primary care doctors differs from that of men's visits in several ways. For example, compared with men's visits, women's visits involved more discussion about the results of treatments, more preventive services, less emphasis on physical exams, and less discussion about alcohol, tobacco, and other drug use. Visit length was similar for women and men. These findings are based on previsit interviews and videotaping of actual medical visits for 315 women and 194 men who were cared for by 105 primary care physicians. Bertakis and Azari, J Women's Health 16(6):859-868, 2007 (AHRQ grant HS06167).

•Women have fewer problems after vascular surgery in VA hospitals than in private hospitals.
Women's mortality rates 1 month after vascular surgery at VA and private-sector hospitals are similar, but they have fewer postoperative problems in VA hospitals, according to this study. Researchers compared postoperative mortality and morbidity for 458 women who had vascular surgery at 128 VA hospitals and 3,535 women who had surgery at 14 private medical centers between 2001 and 2004. After adjusting for severity of illness, 30-day mortality rates were similar; however, there were pronounced differences in postoperative problems between the two groups, with the VA group suffering from 40 percent fewer postoperative complications than the private group. The complications that were more frequent in the private group included deep wound infection, respiratory failure, urinary tract infection, cardiac arrest, and graft failure. Johnson, Wittgen, Hutter, et al., J Am Coll Surg 204(6):1137-1146, 2007 (AHRQ grant HS11913).

•Quality of health care varies for older women.
Women make up more than half (60 percent) of the Medicare population, and they depend on the program for an average of 15 years compared with 7 years for men. This study examined quality of care for older women compared with older men. It shows that older white women tend to receive better quality of care than their Hispanic and black counterparts, and more educated women often receive better quality of care than less-educated women. Also, older women are much less likely than older men to receive a number of preventive tests, have their blood pressured under control, or receive aspirin or a beta-blocker upon hospital admission or discharge for heart attack. Results are mixed for diabetes care and vaccinations for flu and pneumonia. Kosiak, Sangl, and Correa-de-Araujo, Women's Health Issues 16(2):89-99, 2006 (AHRQ Publication No. 06-R046)* (Intramural).

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Women's Health Highlights: Recent Findings (continued)