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Senior Citizen Health & Medicine
Women with Heart Disease and Diabetes Get Less Care
Than Men
Women on Medicare fare better than those on private
insurance
May 14, 2007 - Women with heart disease and
diabetes are less likely to receive several types of routine outpatient
medical care than men with similar health problems. Women covered by
Medicare, however, received more care than those on private insurance,
according to a RAND Corporation study issued today.
While previous research has shown that women less
frequently receive expensive medical care such as angioplasty for heart
disease, few studies have evaluated gender disparities in managed care
settings.
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All the patients in the RAND Health study had
either private insurance or were enrolled in Medicare managed care
plans, had been diagnosed with heart disease and/or diabetes, and had
visited health providers to receive care. The study is published in the
May/June edition of the journal Women’s Health Issues.
"We found that the routine medical care received by
women for their heart disease and diabetes was not as good as the care
received by men," said Chloe Bird, the study’s lead author and a
sociologist at RAND, a nonprofit research organization. "These are
low-cost treatments that can forestall serious health problems in the
future -- and women with diabetes and heart disease are not receiving
them as often as men with similar problems."
Researchers studied more than 50,000 men and women
enrolled in both commercial and Medicare managed care plans in 1999. The
study examined 11 different screening tests, treatments or measurements
of health status shown to be important to all people diagnosed with
heart disease or diabetes.
Among people enrolled in commercial health plans,
women were significantly less likely than men to receive the care
evaluated in six of the 11 measures, while women enrolled in the
Medicare plans were less likely to receive the care evaluated in four of
the 11 measures.
The largest disparity found by researchers was that
women were less likely to lower their cholesterol to recommended levels
after suffering a heart attack or other acute cardiac event, or if they
had diabetes.
For example, women with diabetes were 19 percent
less likely than men to have their cholesterol within recommended ranges
if they were enrolled in Medicare and 16 percent less likely than men to
have cholesterol with recommended ranges if enrolled in commercial
health plans.
Other types of care women received less often than
men included being prescribed ACE inhibitor drugs for chronic heart
failure and receiving prescriptions for beta blocker drugs following a
heart attack.
Women with diabetes in both Medicare and commercial
health plans were more likely to have received eye exams than their male
peers.
The disparities were found among women even though
they generally see a doctor or other health care provider more often
than men. The disparities also remained after researchers accounted for
socioeconomic factors that may influence care.
"These were all insured people. They all had access
to medical care and they were all diagnosed with these diseases," Bird
said. "The disparities cannot be explained by a lack of patient
reporting or not recognizing the symptoms of a disease."
Bird said that more research needs to be done to
understand why there are gender differences in outpatient care.
"As we become a nation with an older population,
the type of routine preventive care we studied will become even more
important," Bird said. "Understanding these gender differences may allow
us to improve care."
The RAND study is one of four published in the
latest edition of Women’s Health Issues reporting on studies that found
gender disparities among patients treated in managed care settings.
"Taken together, these studies make a compelling
case for routine assessment and reporting of selected quality indicators
by gender," said Dr. Allen Fremont, the lead author of an accompanying
editorial and co-author of the RAND study. Fremont is a natural
scientist and sociologist at RAND.
Editor’s Notes
Funding for the RAND study was provided by the U.S.
Agency for Healthcare Research and Quality. The article is titled "Does
Quality of Care for Cardiovascular Disease and Diabetes Differ by Gender
for Enrollees in Managed Care Plans""
Other authors of the study are Dr. Arlene S.
Bierman of the University of Toronto; Steve Wickstrom and Thomas
Horstman of Ingenix; Mona Shah of United Healthcare; Thomas Rector of
the Minneapolis Veterans Administration Medical Center and the
University of Minnesota; and Dr. Jose J. Escarce, of RAND and the David
Geffen School of Medicine at UCLA.
RAND Health, a division of the RAND Corporation, is
the nation’s largest independent health policy research program, with a
broad research portfolio that focuses on quality, costs and delivery,
among other topics.
The RAND Corporation is a nonprofit research
organization providing objective analysis and effective solutions that
address the challenges facing the public and private sectors around the
world.
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