Health insurance pools risk and redistributes costs among the members of society. Women tend to accrue greater health care costs than their male counterparts. Under the Affordable Care Act all health insurance premiums – for men and women – will be created equal.
Although past studies have shown that the differences in personal health care spending between men and women are minimal, a new analysis shows that if the data is broken down to information on per-capita spending, women are spending more than 30 percent more than men per year on health care expenses: $5,989 versus $4,541. Performing more sub-category analyses by age group and type of health care service sheds light on why this vast difference exists.
Dividing personal health care services into the categories of hospital care, clinical services, nursing home care, and prescriptions, the increased spending by women of all ages seems to be the most affected by womens higher spending on nursing home care. Overall, women, who make up almost 75 percent of those over age 65 who live in skilled nursing facilities, spend $77 billion dollars on nursing home care per year compared to men who spend $39 billion per year. That being said, women spend more than men in each category per capita.
This is not necessarily the case, however, when you look at spending for each service category by age groups: 0-18 years, 19-64 years, and 65 and older. Probably because of maternity care, women do spend more than men for hospital care during the ages of 19-64. Men, on the other hand, spend much more than women on prescriptions in the ages 0-18 years and on nursing home care in the ages of 19-64. The difference in prescription spending is theorized to be due to the large difference in the pharmaceutical treatment of, but not the prevalence of, ADHD among boys as compared to girls. Men may spend more than women on nursing home care at a younger age because of the higher incidence of trauma and congenital abnormalities among young men. Interestingly though, this may also be a reflection of mens lower spending, possibly inappropriately so, on clinical services during the ages of 19-64, which may lead to earlier onset of debilitating disease such as heart attack and stroke.
Studies show that women pay 25-85 percent more than men on health care premiums for comparable health care coverage. The upper end of this spectrum seems exorbitant seeing as womens overall spending on health care per capita is approximately 30-35 percent more than mens.
On the other hand, does it make sense that the Affordable Care Act of 2010 prohibits third party payers from charging varying premiums based on gender? In other cases of differential health care spending among subcategories of the insured, such as age, premiums are permitted to vary, but are limited to a ratio of 3 to 1 between the most costly and least costly subcategories.
Although this type of compromise cannot be done for every aspect that may statistically make an insured individual at risk for higher health care spending, gender makes a significant difference in overall healthcare spending. As third party payers become prohibited from charging differential premiums based on gender, we must keep in mind that this differential in expense will be passed on to the male insured population.
Lisa Maurer, MD