BACKGROUND * Studies have shown that women use more health care services than men. We used important independent variables, such as patient sociodemographics and health status, to investigate gender differences in the use and costs of these services.
METHODS * New adult patients (N = 509) were randomly assigned to primary care physicians at a university medical center. Their use of health care services and associated charges were monitored for 1 year of care. Self-reported health status was measured using the Medical Outcomes Study Short Form-36 (SF-36). We controlled for health status, sociodemographic information, and primary care physician specialty in the statistical analyses.
RESULTS * Women had significantly lower self-reported health status and lower mean education and income than men. Women had a significantly higher mean number of visits to their primary care clinic and diagnostic services than men. Mean charges for primary care, specialty care, emergency treatment, diagnostic services, and annual total charges were all significantly higher for women than men; however, there were no differences for mean hospitalizations or hospital charges. After controlling for health status, sociodemographics, and clinic assignment, women still had higher medical charges for all categories of charges except hospitalizations.
CONCLUSIONS * Women have higher medical care service utilization and higher associated charges than men. Although the appropriateness of these differences was not determined, these findings have implications for health care.
KEYWORDS * Health care costs; sex differences; costs and cost analysis. (J Fam Pract 2000; 49: 147-152)
Studies have consistently shown that women use more health care services than men.[1,4] Several explanations have been offered. These differences may be associated with reproductive biology and conditions specific to gender,[3,5-6] higher rates of morbidity in women than in men,[1-4] differences in health perceptions and the reporting of symptoms and illnesses, or a greater likelihood that women seek help for prevention and illness,[1-4] Physician referral practice patterns may also partially explain the rates of specialty care and diagnostic testing. Men are referred to specialty care more often than women, and hospitalized men are more likely to be referred for invasive cardiac procedures than women.[8-9]
The authors of some previous studies describing gender differences in the use of health care services have examined large secondary data sets without incorporating important independent variables, such as sociodemographic information or patient health status.[3-5] Other researchers have attempted to control for health status by including in the study population only those individuals rating their health as good or excellent. Still others have used limited health status measures that have not been tested for reliability and validity.
Although there have been a number of studies demonstrating distinctive patterns in the use of health care by women, few have reported associated health care expenditure differences. A recent study from Canada (a country with a system of universal health insurance) presented data on the crude annual per capita use of health care resources for men and women in the province of Manitoba. Using administrative data from electronic records, the investigators concluded that expenditures for health...
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