By Kristen Gerencher
Market Watch - Sunday 10 July 2005
San Francisco - Despite making many of the household health-care decisions and using medical services more often than men, more than one in four U.S. women are delaying care they think they need because of costs, according to a new study.
"The issue of costs is one that cuts across all insurance groups of women, both privately insured and uninsured women," said Alina Salganicoff, vice president and director of women's health policy at the Kaiser Family Foundation, which recently surveyed more than 2,700 women on health questions.
The overall portion of women delaying care due to costs rose to 27% in 2004 from 24% in 2001. The portion of working-age women without health insurance who delayed or chose not to get needed care ballooned to 67% from 59% in 2001, the study said.
Working-age women with private coverage weren't home free either: 17% of them put off care because they couldn't afford it, up from 13% four years ago. And 20% of women didn't fill a prescription for similar reasons versus 14% for men.
Screening rates for cancer-prevention techniques such as mammograms and pap smears slipped slightly, with 69% of women age 40 to 64 receiving mammograms last year compared with 73% in 2001. The rate for pap smears, which can catch early cervical cancer, dropped to 76% of women 18 to 64 from 81%.
Those declines may be difficult to interpret, Salganicoff said, because of disagreement within the medical community over the value of mammograms and new guidance about weighing individual risk for determining a patient's timetable for pap smears.
But the overall trend suggests cost-shifting is making women more reticent to get care they may need, she said.
"We don't really have any good options on the table to control health-care costs," Salganicoff said. "What we've been doing in the past decade is putting costs onto the health-care consumer in terms of premium costs, higher deductibles, higher copays."
Women also are more likely than men to be working part time or in jobs without benefits, and they tend to be covered as a dependent on a health plan more frequently, she said. "Should they become widowed or divorced, they're much more vulnerable to losing their coverage."
Health Promotion Lacking
Chronic conditions and mental-health care are also a concern. More women than men - 38% to 30% - have a chronic condition such as diabetes, asthma or high blood pressure that requires ongoing medical management, according to the study.
At 23%, women were diagnosed with anxiety or depression at twice the rate of men. But few had discussed mental and behavioral health issues with a doctor in the last three years. Fewer than half talked about calcium intake and only one-third touched on smoking as a health issue, the survey said.
Sexual health topics also received little attention. Only 31% of women 18 to 44 said they had a conversation about HIV/AIDS, and just 14% said they discussed emergency contraception with a doctor in the last three years.
Such omissions may reflect patients' reluctance to discuss sensitive topics or doctors' limited role in a fragmented system, Salganicoff said.
"In the case of drug abuse or domestic violence, it may be dealing with issues outside the medical arena but that still impact on women's health care," she said. "We don't have a situation where we pay doctors to provide this counseling service."
Even so, health-care providers are the preferred source of health information for 53% of women, with friends and family coming in a distant second at 16% and the Internet close behind at 15%.
Breast Cancer, Heart Disease Top Fears
Another survey suggests women's fear of heart disease is catching up to the risk they actually face from it.
When asked what disease they fear the most, breast cancer remains women's most dreaded diagnosis this year, according to a survey of more than 1,000 women from the Society for Women's Health Research.
But the female fear of heart disease has almost doubled since 2002 to 9.7%, perhaps reflecting a growing awareness that heart disease kills 500,000 American women each year - 50,000 more women than men, the survey said. Heart disease, including heart attack, hypertension and related heart ailments but not stroke, strikes women on average 10 years later than men.
In fact, heart disease was the leading cause of death for women in 2002 at 28.6%, followed by cancer at 21.6%. Stroke was a distant third, causing 8% of female deaths, followed by chronic lower respiratory diseases and Alzheimer's disease.
Cancer in general remains women's biggest scare-inducing disease, said Sherry Marts, vice president for scientific affairs for the Society.
"With cancer, it's a fear not only of the disease but also of the treatment of the disease," Marts said. "It's unpleasant surgeries and losing your hair...."
"The fear of breast cancer hasn't changed despite the fact that there's been a fair amount of publicity that breast cancer has become increasingly survivable," she said. "If caught early enough, you're quite likely to survive."
Women's fear of HIV/AIDS dipped to 9.3% from 11.3% three years ago, even as women's AIDS cases increased 15% from 1999 to 2003 versus a 1% increase for men, the survey said.
Giving and Taking Care
Fear of Alzheimer's disease nearly doubled to 4.6% this year, the society's study said. That may be due to what women see upon becoming caregivers, a role they assume more often than men.
About 12% of women in the Kaiser study said they care for a sick or disabled relative, and that percentage is projected to rise as baby boomers age, Salganicoff said.
What's more, nearly three out of 10 female caregivers spent at least 40 hours a week providing care, she said. "That's a full-time job, and many of these women are already working. A lot of women have to stop working and they become low-income."
Ironically, making time to care for the caregiver's health may be the toughest job of all, Marts said. "Things like watching what you eat and getting a chance to exercise become a challenge when you work outside the home and possibly care for an elderly relative."
Still, women are well served to work even a small amount of physical activity into their schedules and to ask their doctors about appropriate medical screenings and smoking cessation programs if they still light up, she said.
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