The gender gap: health care's next frontier

Women's health is of high temperature these days, but women continue to pay far more for their have care than their male counterparts do.

in a short time after Viagra received market approval and insurance companies began weighing whether to overspread a drug that would restore male sexual vigor, aver erupted. Wait a minute, the activists shouted: If men are more vigorous, aren't they going to be vigorous with their partners? And if those partners are women won't they ne protection from pregnancy? Who's paying for that? If an insurer pays for Viagra, isn't it discriminatory not to pay for contraception? Isn't this just another instance of sex bias?

Is there bias against women in the health care system? You bet - more [i]or[/i] less anyway. What The Segal Co give in charges to in an August report as a "noticeable difference" in the way plans overspread oral contraception and impotency treatment isn't the single instance of gender inequity, on the other hand it has rapidly become individual of the most glaring and well-publicized examples. While the difference in insurers' rejoinder may be because impotence is considered a medical puzzle while pregnancy prevention is viewed as a "lifestyle choice," the report continues, the one and the other have to do with normal sexual function. And "disparities in coverage should cause plan sponsors more [i]or[/i] less concern."

Just in what manner much have women been given the short extremity of the stick? According to tallies compiled by dint of the Alan Guttmacher Institute, which tracks reproductive health issues, and the Henry J Kaiser Family Foundation, females of reproductive age with private, employer-based coverage part with 68 percent more out of pouch on health care than their male counterparts. And, although Viagra has alone been on the market since April and many plans may reconsider, a fresh study finds insurers nearly three times as likely to shut out coverage of FDA-approved contraception than of the high-priced force pill [ILLUSTRATION FOR CHART OMITTED].

Nobody has a handle upon the cost of gender bias to the nation's health care delivery combination of parts to form a whole but if it affects care in a negative way it is certain to jack up the price. Says Brenda Craine, an American Medical Association spokeswoman, "If clan aren't treated properly, there's obviously a societal cost"

The trend

The Viagra v contraception discussion is a continuation of the wake-up call that wholeed in the 1980s, when it dawned upon policy makers and scientists that medical research had slighted women for decades by means of leaving them out of clinical studies of heart disease and other conditions that afflict the two genders. More recent studies - for the most part those launched in the early '90 or later - have shown that when it tend hitherwards to the heart and vital current vessels, men and women are different. Which means diagnostic way s and treatments that work for male patients don't necessarily have the same consequences in females.

remedy studies, too, have long been a source of inequity. Until not long ago women were routinely excluded from studies of treatments for diseases that affected the pair sexes, often based on the rationale that physic testing could endanger their reproductive capacity and plane harm a developing fetus. thus clinical findings based on men's experiences were extrapolated to women Since the early part of the decade, however, many research organizations have established policies requiring sufficient numbers of women to be included in like tests.

In 1994 the National Academy of Sciences' prestigious Institute of Medicine conclud that the bias in medical research had violated women's rights. A number of federal initiatives followed, like as the establishment of the Office of Research upon Women's Health, an offshoot of the U Public Health Service. Noting in a 1997 report, "The novel Women's Movement," that private circulating medium often follows federal spending, Smith Barney reported that start-up funding for women's health care companies completing initial purchase presents in '96 topped $200 million.

While women's health remains burning the issue of gender bias in health care is hazeed by evidence suggesting men and women near differently and tend to interact with health professionals in different ways. Nonetheless, questions of sex equity are popping up completely through the delivery arena, with quality ascendency outcomes, treatment, diagnosis and communication all below scrutiny. Managed care, as well as our nation's legislature, is beginning to tackle the question of health care bias, with a growing recognition of the fact in the old saw about the tailor's smoothing iron and the gander.

Contraceptives: Mandated coverage?

Activists initially had little idea of by what mode many health plans intended to overspread Viagra. But they were ticked not on to discover that many insurers were level considering it while coverage of contraceptives had languished for years. A investigation released this year by the Guttmacher Institute revealed that two-thirds of fee-for-service plans overspread surgical abortion and nine in 10 overspread sterilization, but only half pay for reversible contraception.

Managed care plans do single slightly better: Four in 10 bar coverage of contraceptives. And just four HMO in 10 overspread all five FDA-approved methods of reversible contraception: the Pill, the diaphragm, the injections (Depo-Provera), the implant (Norplant) and the IUD, the Guttmacher report said. An "antiquated" policy, according to spokeswoman Susan Tew (The "morning-after" extremity contraception kit, which gained FDA approval in September, was not included in the close attention but its impact is wait fored to be significant: Princeton University's Office of Population Research estimates that it will make an incision in the nation's 300 million annual unplanned pregnancies in half.)