Health Care 523•Women make three-fourths of the health care decisions in
American households and spend almost two of every three
health care dollars.ŽIt has also been noted that more than 61%
of visits to physicians are made by women, 59% of prescription
drugs are purchased by women, and 75% of nursing home resi-
dents over the age of 75 are women. These statistics suggest that
women continue to make a large proportion of health care deci-
sions for their family as they have historically, especially re-
garding their children and elderly relatives (Of“ce of Women•s
Health, 2000). Women typically visit their doctors on a regular
basis and use preventive services twice as much as men, but,
unfortunately, women spend more money out-of-pocket for
needed medical care (Commonwealth Fund, 1994).
Health Insurance
Managed care is a signi“cant source of women•s health care.
Women usually have some type of insurance coverage; how-
ever, they are more likely to be covered by public insurance,
speci“cally Medicaid (Clancy, 2000). Furthermore, women
are substantially more likely than men to have minimal or no
coverage because they represent the majority of part-time
and service employees (Commonwealth Fund, 1994).
Women of color and women with low incomes have the
highest risk of being uninsured (OWH, 2000). As expected,
women without health insurance go without needed medical
care, especially vital preventive services including mam-
mograms and Pap smears (Commonwealth Fund, 1994).
Insurance also in”uences use of various health care services
and treatment options. For example, women in HMOs are
more likely to receive medications than psychotherapy com-
pared to women with fee-for-service payment plans (Glied,
1997). The lack of health care coverage also may help ex-
plain why many diseases go undetected in women.
Relationships with Health Care Providers
Women frequently receive services from more than one
physician because reproductive services are traditionally iso-
lated from other health services (Clancy, 2000). As a result,
many women have dif“culty navigating the health care
system to receive appropriate medical care. According to
the OWH, research indicates that women are often unsatis-
“ed with their health care provider or the level of communi-
cation with their provider, and several studies have indicated
that health care providers treat women differently from men.
They also noted that, •Health providers may give women less
thorough evaluations, minimize their symptoms, provide
fewer interventions, and give less explanations in response to
questionsŽ (OWH, 2000).
Studies indicate that the use of preventive care services is
related to the age and sex of the physician, with younger
physicians and female physicians more likely to provide pre-
ventive services (Clancy, 2000). More speci“cally, female
physicians are more likely to provide Pap smears and recom-
mend mammography to their patients than male physicians
(Franks & Clancy, 1993; Lurie et al., 1993). In a study con-
ducted by Lurie, Margolis, McGovern, Mink, and Slater
(1997), physicians and patients were surveyed to see why
higher rates of breast and cervical cancer screening occur
among female physicians. The results indicated that higher
rates of screening occur because women prefer female physi-
cians and that female physicians are more concerned about
prevention issues. Female physicians spent more time
per visit with patients than male physicians and were more
concerned about prevention issues (e.g., smoking, sexual
practices, seatbelt use, and cancer screening). Furthermore,
female physicians reported feeling more comfortable per-
forming breast exams and Pap smears, as well as taking a
sexual history from women.
Studies have also revealed that male and female physi-
cians communicate differently with patients. Roter, Lipkin,
and Korsgaard (1991) analyzed 537 audiotapes of medical
visits to evaluate gender differences in communication be-
tween physicians and patients. Female physicians talked
40% longer than male physicians during the history-taking
segment of the visit. Likewise, patients of female physi-
cians talked 58% more during the history-taking segment of
the visit. Female physicians spent more time with patients,
and patients of female physicians asked more questions and
gave more relevant health-related information. Hall, Irish,
Roter, Ehrlich, and Miller (1994) conducted a similar
study to analyze the relationship between gender and physi-
cian/patient communication in a primary care setting.
Physicians and patients were videotaped during medical
visits. The “ndings revealed that female physicians talked
more and asked more questions than male physicians, and
engaged in more positive, nonverbal behavior (e.g., smiling
and nodding) than male physicians. Patients of female
physicians communicated more and gave more medical
information.
In summary, women are the primary consumers of the
health care industry yet often are underinsured and unsatis-
“ed with their health care relationships. These issues can
affect women•s mortality and morbidity in numerous ways
(e.g., underutilization of preventive and medical services,
inadequate communication with health care providers, and
limited availability of treatment options). As a result, efforts
should be made to ensure that women have adequate access
to quality health care, and health providers should be