Women, Poverty, Access to Health Care, and the Perils of Symbolic Reform

This article looks at health care through gendered eyes. We sift though available data on access to health care, health status, and health treatments to determine whether men and women experience health care differently in the United States. While we do not doubt that overt gender-based discrimination occasionally occurs in health care, this article focuses on the importance of unintended consequences and unconscious bias. We also explore the impact of symbolism about women\u27s roles on the process of health care reform. The results have important implications for policy makers, advocates, and health care providers. The United States has a large and complex health care system. Health care consumed $1.1 trillion, over 13%, of the Gross Domestic Product in 1998. A little over half of the health care expenditures came from private funds; slightly less than half of the expenditures were paid from public funds. Virtually every layer of government makes public expenditures, from the federal Medicare program down to immunization programs run by local governments. Health care services were provided in nearly 6,000 hospitals by over 812,000 physicians and other types of heath care providers. Given the enormity of the system, one might reasonably ask whether the objectives of this paper are quixotic. Where should researchers begin the search for gender-related differences? Part I begins by analyzing data on health care status, treatment, and outcomes for men and women. The data on health care status is intriguing because women have a longer average life expectancy than men. Part II then reviews the conflicting evidence about gender-related differences in health care treatments and outcomes. Part III carries these themes forward by emphasizing the connection between access to care and access to health insurance. We explore the data on access to health insurance for women and conclude that women and men are insured at similar rates. Women are more likely, however, to be covered by public health insurance programs. In Part IV, we analyze the role of gender in the private and public insurance markets. We demonstrate how women\u27s increasing political power has resulted in greater regulation of the private insurance market in ways that, at least symbolically, benefit women covered by the private market. Part IV also explores the negative impact of the politicization of public health insurance. Part IV examines the impact of symbolic reforms in the public provision of health benefits. We note that women are disproportionately at risk for governmental intrusion into personal health decisions because they are more likely to be poor or old and, therefore, are more likely to be covered by public insurance programs. In Part V, we analyze the implications of a gendered analysis of the health care system. We conclude that further research is needed on the relationship between gender, health care treatment, and health care outcomes. Finally, we explore the lessons learned from symbolic attention to women\u27s needs in the private health insurance market and to women\u27s proper roles in the public provision of health benefits