Charges for primary care, specialty care, emergency treatment, diagnostic services, and yearlong total charges were all significantly higher for women. Although it is logical that the higher mean numbers of primary care visits and diagnostic tests for women would be associated with higher charges for these services, it was also observed that specialty care and emergency treatment charges were higher for women despite visit rates similar to those of men. The poorer health status of women may have led to more complicated and costlier care when they were seen in the specialty clinics or emergency department compared with men who had better baseline health. Both the mean number of hospitalizations and related hospital charges, however, were not different for men and women. This confirms the work of Verbrugge and Wingard,4 who also observed that although women use more outpatient services, they have similar or lower rates of hospitalization than men.
Regression equation analysis highlighted the importance of physical health status, age, and clinic assignment in the prediction of medical charges. Lower physical health status and advancing age both predicted higher medical charges. Clinic assignment was also found to be related to medical charges. As seen in our previous study,11 patients’ assignment to care by internists versus family physicians was associated with higher charges for primary care and emergency department care. Even after controlling for clinic assignment, health status, age, and other sociodemographic variables, women continued to be associated with higher medical charges for all categories of charges except hospitalizations. Higher health care utilization and associated charges did not lead to significantly better health outcomes for women.
The differences we found may result from patients’ health beliefs and help-seeking behavior. Women have been found to be more predisposed to report their health as poor.3 They also have a greater willingness and ability to take care of themselves when they are sick and to seek preventive care.4 Physicians, in turn, may respond to these attitudinal and behavioral characteristics in women by providing them with differential diagnosis and treatment.
The strengths of our study include the fact that we measured health status with a widely used instrument that allowed us to control for this important variable. We also controlled for sociodemographic variables and physician specialty to more accurately assess the influence of patient gender on health service utilization. In addition to information about utilization patterns, medical charge data were available to compare costs of care for men and women.
Limitations
There were a number of limitations which should also be noted. Our study was conducted at a university medical center with primary care resident physicians. These physicians-in-training may be more likely to differentially care for patients on the basis of patient gender. In addition, patients participating in the study had no preference for a specific physician or specialty. It may also be true that the study patients represent a different population than those cared for in the community. It was found, for example, that both the self-reported physical and mental health status scores for these study patients were lower than national means. Although we included only nonpregnant adults (not requiring obstetrical care) and controlled for health status, we did not attempt to control for differences in health care utilization associated with gender-specific problems. Also, we did not measure patient health attitudes, which may be an important factor in seeking and using health services.
Conclusions
Our hypothesis was confirmed: Women used more medical services and have higher outpatient expenditures than men, even when controlling for health status and other variables. We cannot judge the appropriateness of these gender differences in resource utilization. There was a trend, though not significant, for women to report a greater improvement in their physical health status than men. It is possible that these men underused health care resources and had unmet medical needs. Future studies examining differential health care utilization need to incorporate appropriate patient health outcome measures. This research has implications for health care organizations that seek to provide quality comprehensive care that is cost efficient for both men and women.
Acknowledgments
Our research was supported by the Agency for Health Care Policy and Research Grant R18 HS06167.