A recent Deloitte report, “Hiding in plain sight: The health care gender toll,” sheds light on a concerning gender disparity in healthcare, revealing the disproportionate financial burden that women bear in accessing medical services compared to men.
A few key findings from the report include:
The “pink tax”: The report discusses the “pink tax” in healthcare, which refers to a phenomenon where products and services explicitly marketed to women are priced higher than equivalent products and services marketed to men. In healthcare, this can manifest in various ways: the cost of maternity care, pricing of gendered health products, and gender bias in medical research.
Out-of-pocket costs: Out-of-pocket healthcare costs are estimated to be over $15 billion more per year for employed women than for employed men. Women’s out-of-pocket medical costs consistently exceed men’s among 19-64-year-olds, even when excluding pregnancy-related services. For those with single coverage, female employees have approximately $266 more in out-of-pocket spending per year than male employees. This represents over 18% more than men’s out-of-pocket costs.
Insurance costs: It’s true that employers must offer insurance premiums at equal costs to women and men, but as the study emphasizes, “…premiums are only part of the financial story.” The analysis says that health insurance products may indirectly contribute to a gap in net income for working women.
Gender wage disparity: The existing gender income disparity (women earn around $0.82 for every dollar men make; Black and Latinx women earn even less, $0.70 and $0.65, respectively, relative to white men) exacerbates financial burdens and can in some cases force women to choose between necessary healthcare and managing their financial well-being.
The report brings to mind key themes that women’s health experts and feminist activists have been tirelessly emphasizing for decades: social inequalities, systemic oppression, sexism, and racism are having a detrimental impact on the overall health of marginalized populations, especially women. Four themes, which I have outlined below, are key to understanding the factors that contribute to the gender healthcare gap.
Patriarchy as the Most Important Determinant of Women’s Health
Gender-based health disparities are, to a large extent, a result of profoundly ingrained power imbalances. Patriarchal ideologies play a pervasive role as a significant determinant of women’s health. They influence various aspects such as decision-making, healthcare coverage, access to treatment, and manifestation and diagnosis.
The Role of Insurance Coverage in Feminization of Poverty
Health systems often fail to adequately account for women’s and sexual minorities’ unique healthcare needs and experiences, further exacerbating the financial burden placed on them. Meanwhile, insurance companies profit from their health needs.
According to the Center for American Progress, women constitute the majority of individuals living in poverty. Women also endure more severe and prolonged periods of poverty, and encounter more challenges when breaking free from poverty. This suggests that gender disparities persist within impoverished populations.
Sexist Policies and Increased Service Utilization
Higher out-of-pocket expenses can be driven by many factors, including sexist social and healthcare policies that may lead women to seek healthcare services more frequently. Examples of such policies include limited access to contraception coverage, optional maternity coverage, pregnancy as a preexisting condition, and inadequate coverage for preventive services. These policies can also drain women’s physical and mental well-being as they navigate a healthcare landscape that may not fully address their needs.
Intersectionality in Healthcare Expenditures
This study raises questions about how gender may intersect with race to fuel health and health coverage disparities. CDC data indicate that racial and ethnic minorities often have less access to healthcare coverage, compounding the challenges faced by women from these communities. The intersection of gender, race, and class requires a comprehensive examination.
The impact of gender disparities in out-of-pocket expenses extends beyond maternity. It interacts with social determinants of health, including employment status, marital status, racialization, immigration status, sexual orientation, ability status, and ZIP code. The Affordable Care Act expanded coverage to include maternity care and related services but did not resolve the issue of higher out-of-pocket health expenses for women.
The Deloitte report offers valuable insights in discussing health equity, and I applaud the report for including recommendations to close the gender gap in healthcare coverage. It emphasizes the need for gender-specific insurance coverage and encourages organizations to evaluate the equity of out-of-pocket expenditures. It also highlights the need for intentional reviews of benefit design to help all employees regardless of gender.
Studies show that globally, greater gender equality is associated with longer lives for both men and women. This report should serve as a wake-up call to political leaders, policymakers, business leaders, and healthcare stakeholders and inspire them to act now. By working together to actively implement the report’s recommendations, we can strive for a healthcare system that truly provides equitable access and care to all individuals.
Judite Blanc, PhD, is assistant professor of psychiatry and behavioral sciences at the University of Miami Miller School of Medicine.