Sex, Access, and Excess

Otudies documenting sex differences in the use of inva-sive technological services are frequently cited as evidence that women receive lower-quality care than men. How-ever, closer examination of sex differences in health care use shows an apparent inconsistency: Although women receive fewer invasive technological services than men, they use more primary care services and live longer. In addition, most literature on sex differences has focused on differences in the use of technological services; scant at-tention has been given to the patient's perspective of quality of care. We believe that the debate on sex bias has obscured the importance of differences between men and women with respect to their decisions to seek health care, their involvement in and subsequent use of that care, and health outcomes. Women use primary care more frequently than men (1) and receive more health care services (2), even excluding reproductive services. The fact that men use primary care services less frequently may indicate underuse. Men are less likely than women to have visited a physician within the previous 2 years but are more likely to be hospital-ized, excluding conditions related to reproduction (1). A growing body of literature suggests that higher rates of hospitalization for some conditions may be viewed a