Gender Inequality in Health Care: Ethics and Access

Introduction

More than in any other industry, concerns involving patients and their well-being are of the utmost significance in healthcare. Those working in this field deal every day with circumstances that have a direct impact on another person's quality of life. It is therefore essential for all healthcare organizations to maintain an ethics committee, a written code of ethics, and rules governing right conduct, so that the interests of all parties — patients, family members, the organization itself, caregivers, and the community — are properly protected.

This lack of ethical business behavior, or perhaps a combination of contributing factors, raises serious concerns when we examine healthcare in the United States. People carry their character with them regardless of their profession; those who cut corners in banking may be the same types of individuals who cut corners in healthcare. Worse still are those who deliberately provide lesser care to a patient when they know they could do more.

Studies from around the world consistently show that women face significantly greater obstacles in accessing quality health care due to gender-based differences in education, income, and employment. These unequal power dynamics translate into inadequate access to care. The World Health Organization is working to improve healthcare for women and girls globally, but that effort cannot progress as long as women are still treated as second-class citizens in so many parts of the world. It is a clear ethical issue that women are not receiving the same quality of healthcare as men (McAlister, 2010). Recognizing that gender-based disparities negatively affect healthcare outcomes is a first step in the right direction — but is the problem actually being resolved? This essay discusses gender inequality in healthcare, covering doctor visits, insurance, medical procedures, research funding, and their effects on spending.

Women and Doctor Visits

Research consistently shows that while women have historically lived longer than men, they also experience higher rates of illness. Women make significantly more visits to doctors, hospitals, and emergency rooms, and undergo more surgical procedures than men — even after controlling for pregnancy-related care.

Ethnicity and social class play a major role in women's healthcare utilization. The number of women seeing a physician and the average number of doctor visits are both meaningfully lower for African American women than for White women at every income level. Women with lower incomes are the least likely to seek physician care regardless of cultural group. Among the poorest women, African American women are hospitalized at lower rates than White women. Hospitalization rates for African American and White women do not differ as substantially among higher-income groups. Women from Latina backgrounds, however, have lower overall hospitalization rates and lower rates of care than White women across every income group.

Many women face such heavy workloads that they have little time for doctor visits. In developing countries, women typically work what is described as a "double day" — approximately eight hours of paid work outside the home, followed by unpaid domestic labor. While the availability of indoor plumbing, gas, electricity, and modern appliances has reduced some of the heaviest physical home labor, women in these countries still devote approximately 25 to 31 hours per week to domestic tasks, compared to just 1 to 12 hours per week for men, according to a 1991 UN report. As a result, the combined hours devoted to paid and unpaid work mean that the average woman in industrialized countries works 70 to 75 hours per week, compared to 51 to 55 hours for men.

This exhaustion takes a measurable toll on women's health, manifesting as headaches, backaches, and higher rates of viral and bacterial illness. For example, more than 70% of American women report regular headaches, compared to only 45% of men. Women in developing nations are also frequently exposed to toxic substances through housework. Elevated rates of certain cancers among women are suspected to be partly a consequence of repeated exposure to bleach, pesticides, cleaning fluids, and detergents.

Insurers and employers argue that their rating structures, tied to coverage obligations, would not function without gender-based pricing and should therefore be preserved if a court voids the individual mandate. A prohibition on gender assessment could thus be affected by the outcome of related court cases. Federal law already prohibits insurers from using many factors historically used to set charges. Beginning in 2014, insurers would not be permitted to charge higher rates to sick individuals, and could vary rates based on age and tobacco use only to a limited degree. Additionally, the law broadly forbids sex discrimination under any health service or program that receives federal financial assistance.

Cost of Insurance

The Affordable Care Act would prohibit "gender rating" starting in 2014. Nonetheless, gaps persisted in many states, with little evidence that insurers were taking steps to close them. For a popular Blue Cross Blue Shield plan in Chicago, a 30-year-old woman was paying $375 per month — approximately 31% more than a man of the same age for the same coverage, according to eHealthInsurance.com. In a report issued at the time, the National Women's Law Center noted that in states that had not banned gender rating, more than 90% of the best-selling health plans were charging women more than men.

A former deputy insurance commissioner in Florida noted that these findings were consistent with her own observations: "The gender gap is still going on strong." She added that if insurers voluntarily narrowed the gap, they could reduce the disruptive impact expected in 2014, when rates were projected to rise for many men under the age of 55.

Kristin E. Binns, a spokeswoman for WellPoint, one of the largest underwriters, noted that "rates being quoted today will probably still include age rating and gender" except in states where the practice is prohibited by law. Fourteen states — including New Jersey, New York, and California — had taken steps to limit or ban gender rating in the individual insurance marketplace.

Insurers argued that they charged women more than men because claims data showed that women in the 19–55 age group tended to use more health care services. They were more likely to visit physicians, obtain regular checkups, take prescription drugs, and be diagnosed with certain chronic conditions. However, Marcia D. Greenberger, president of the National Women's Law Center, argued that this justification was "extremely questionable," since the differences varied significantly from one insurer to another.

Conclusion

It is clear that inequitable healthcare is becoming a multidimensional problem while simultaneously undermining the principles of good business ethics. Men are treated more favorably in healthcare when it comes to cost and insurance, while women face greater barriers to access. At the same time, men are significantly underserved in research funding and institutional support for male-specific health conditions. The ethics of healthcare are being compromised by what amounts to a false sense of protection — one that serves neither women nor men equitably.

Women's low social status and disempowerment represent a critical and frequently overlooked dimension of injustice in access to and use of maternal healthcare, one that is rarely accounted for in program design or program evaluation. More rigorous assessments employing both quantitative and qualitative approaches are needed to identify and measure the diverse causes of inequity across diverse populations. It is essential to understand the differences in healthcare uptake among the most disadvantaged and most disempowered women, in order to determine whether and how maternal healthcare programs are genuinely addressing gender and poverty inequality — and how to design them to more effectively achieve their intended impact. Greater attention to gender equity in health policy is an indispensable step toward a more just and ethically sound healthcare system.

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