Women spend more of their money on health care than men. And no, it’s not just about 'women’s issues'
<div class="theconversation-article-body">
<p><em><a href="https://theconversation.com/profiles/mike-armour-391382">Mike Armour</a>, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a>; <a href="https://theconversation.com/profiles/amelia-mardon-1505419">Amelia Mardon</a>, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a>; <a href="https://theconversation.com/profiles/danielle-howe-1492317">Danielle Howe</a>, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a>; <a href="https://theconversation.com/profiles/hannah-adler-1533549">Hannah Adler</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>, and <a href="https://theconversation.com/profiles/michelle-oshea-457947">Michelle O'Shea</a>, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a></em></p>
<p>Medicare, Australia’s <a href="https://www.health.gov.au/topics/medicare?language=und">universal health insurance scheme</a>, guarantees all Australians access to a wide range of health and hospital services at low or no cost.</p>
<p>Although access to the scheme is universal across Australia (regardless of geographic location or socioeconomic status), one analysis suggests <a href="https://grattan.edu.au/news/healthcare-out-of-pocket-costs-an-agenda-for-international-womens-day/">women often spend more</a> out-of-pocket on health services than men.</p>
<p>Other research has found men and women spend similar amounts on health care overall, or even that men spend <a href="https://www.publish.csiro.au/ah/pdf/AH18191">a little more</a>. However, it’s clear women spend a <a href="https://www.publish.csiro.au/ah/pdf/AH18191">greater proportion of their overall expenditure</a> on health care than men. They’re also more likely to <a href="https://grattan.edu.au/news/healthcare-out-of-pocket-costs-an-agenda-for-international-womens-day/">skip or delay medical care</a> due to the cost.</p>
<p>So why do women often spend more of their money on health care, and how can we address this gap?</p>
<h2>Women have more chronic diseases, and access more services</h2>
<p>Women are <a href="https://www.abs.gov.au/statistics/health/health-conditions-and-risks/health-conditions-prevalence/latest-release">more likely</a> to have a chronic health condition compared to men. They’re also more likely to report having multiple chronic conditions.</p>
<p>While men generally die earlier, women are more likely to spend more of their life <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(24)00053-7/fulltext">living with disease</a>. There are also some conditions which affect women more than men, such as <a href="https://theconversation.com/how-biological-differences-between-men-and-women-alter-immune-responses-and-affect-womens-health-208802">autoimmune conditions</a> (for example, multiple sclerosis and rheumatoid arthritis).</p>
<p>Further, medical treatments can sometimes be <a href="https://aci.health.nsw.gov.au/__data/assets/pdf_file/0007/967984/CIU-Evidence-Brief-Gender-disparity-and-gender-equality-measures-in-health.pdf">less effective for women</a> due to a focus on men in medical research.</p>
<p>These disparities are likely significant in understanding why women <a href="https://grattan.edu.au/news/healthcare-out-of-pocket-costs-an-agenda-for-international-womens-day/">access health services</a> more than men.</p>
<p>For example, <a href="https://www.aihw.gov.au/reports/men-women/female-health/contents/access-health-care">88% of women</a> saw a GP in 2021–22 compared to <a href="https://www.aihw.gov.au/reports/men-women/male-health/contents/access-health-care">79% of men</a>.</p>
<p>As the number of GPs <a href="https://practices.hotdoc.com.au/blog/the-decline-of-bulk-billing-and-its-impact-on-general-practice-in-australia/#:%7E:text=The%20Medicare%20rebate%20for%20patients,to%20ensure%20their%20financial%20sustainability.">offering bulk billing</a> continues to decline, women are likely to need to pay more out-of-pocket, because they <a href="https://www.aihw.gov.au/getmedia/32ea8a7f-50d5-4047-b70b-92dd63d387b8/aihw-phe239-240-factsheet.pdf.aspx">see a GP more often</a>.</p>
<p>In 2020–21, <a href="https://www.aihw.gov.au/reports/men-women/female-health/contents/access-health-care">4.3% of women</a> said they had delayed seeing a GP due to cost at least once in the previous 12 months, compared to <a href="https://www.aihw.gov.au/reports/men-women/male-health/contents/access-health-care">2.7% of men</a>.</p>
<p>Data from the <a href="https://www.abs.gov.au/statistics/health/health-services/patient-experiences/2020-21">Australian Bureau of Statistics</a> has also shown women are more likely to delay or avoid seeing a mental health professional due to cost.</p>
<p>Women are also more likely to need prescription medications, owing at least partly to their increased rates of chronic conditions. This adds further out-of-pocket costs. In 2020–21, <a href="https://grattan.edu.au/news/healthcare-out-of-pocket-costs-an-agenda-for-international-womens-day/">62% of women</a> received a prescription, compared to 37% of men.</p>
<p>In the same period, <a href="https://www.aihw.gov.au/reports/men-women/female-health/contents/access-health-care">6.1% of women</a> delayed getting, or did not get prescribed medication because of the cost, compared to <a href="https://www.aihw.gov.au/reports/men-women/male-health/contents/access-health-care">4.9% of men</a>.</p>
<h2>Reproductive health conditions</h2>
<p>While women are disproportionately affected by chronic health conditions throughout their lifespan, much of the disparity in health-care needs is concentrated between the first period and menopause.</p>
<p>Almost <a href="https://www.jeanhailes.org.au/news/impact-of-pelvic-pain-vastly-underestimated">half of women</a> aged over 18 report having experienced chronic pelvic pain in the previous five years. This can be caused by conditions such as endometriosis, dysmenorrhoea (period pain), vulvodynia (vulva pain), and bladder pain.</p>
<p><a href="https://www.aihw.gov.au/news-media/media-releases/2023/2023-september/1-in-7-australian-women-aged-44-49-have-endometriosis">One in seven women</a> will have a diagnosis of endometriosis by age 49.</p>
<p>Meanwhile, a quarter of all women aged 45–64 <a href="https://www.jeanhailes.org.au/research/womens-health-survey/menopause-in-australian-women">report symptoms</a> related to menopause that are significant enough to disrupt their daily life.</p>
<p>All of these conditions can significantly reduce quality of life and increase the need to seek health care, sometimes including surgical treatment.</p>
<p>Of course, conditions like endometriosis don’t just affect women. They also impact <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC10501128/">trans men</a>, intersex people, and those who are gender diverse.</p>
<h2>Diagnosis can be costly</h2>
<p>Women often have to wait <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC9518795/">longer to get a diagnosis</a> for chronic conditions. One <a href="https://www.medrxiv.org/content/10.1101/2023.10.12.23296976v2.full-text">preprint study</a> found women wait an average of 134 days (around 4.5 months) longer than men for a diagnosis of a long-term chronic disease.</p>
<p>Delays in diagnosis often result in <a href="https://pubmed.ncbi.nlm.nih.gov/33004965/">needing to see more doctors</a>, again increasing the costs.</p>
<p>Despite affecting about as many people as diabetes, it takes an average of between <a href="https://pubmed.ncbi.nlm.nih.gov/33050751/">six-and-a-half</a> to <a href="https://pubmed.ncbi.nlm.nih.gov/33004965/">eight years</a> to diagnose endometriosis in Australia. This can be attributed to a <a href="https://pubmed.ncbi.nlm.nih.gov/35928674/">number of factors</a> including society’s normalisation of women’s pain, poor knowledge about endometriosis among some health professionals, and the lack of affordable, non-invasive methods to accurately diagnose the condition.</p>
<p>There have been recent improvements, with the introduction of <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/historic-medicare-changes-for-women-battling-endometriosis#:%7E:text=In%20addition%20to%20the%20specialised,with%20complex%20histories%20and%20symptoms.">Medicare rebates for longer GP consultations</a> of up to 60 minutes. While this is not only for women, this extra time will be valuable in diagnosing and managing complex conditions.</p>
<p>But gender inequality issues still exist in the Medicare Benefits Schedule. For example, both pelvic and breast ultrasound rebates are <a href="https://womensagenda.com.au/latest/the-gender-medicare-gap-is-seeing-women-pay-more-for-ultrasounds-and-other-health-services/">less than a scan for the scrotum</a>, and <a href="https://www.endozone.com.au/treatment/MRI">no rebate</a> exists for the MRI investigation of a woman’s pelvic pain.</p>
<h2>Management can be expensive too</h2>
<p>Many chronic conditions, <a href="https://www.tandfonline.com/doi/full/10.1080/0167482X.2020.1825374?casa_token=yIlFZg_vJxsAAAAA%3ALwSa5DBMoDDWTiZsU1FC0MLLXkDd_eWBrGa2gr8b6NeRevp4ynlsTD_IMMYV_ek766j2P5C-B4Qy#d1e167">such as endometriosis</a>, which has a wide range of symptoms but no cure, can be very hard to manage. People with endometriosis often use allied health and <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/imj.15494?casa_token=1sc4ZMGvDjIAAAAA%3AIrIY2B-RNVDDnUPMSsHI4axnBiTv-omNDHGlNSpsrm_qbMGY9iQ4htIyco5mj-Qhd7krsp7rfHtcbQ">complementary medicine</a> to help with symptoms.</p>
<p>On average, women are more likely than men to use both <a href="https://www.racgp.org.au/afp/2017/may/patterns-of-complementary-and-alternative-medi-2">complementary therapies</a> and <a href="https://www.aihw.gov.au/reports/primary-health-care/general-practice-allied-health-primary-care">allied health</a>.</p>
<p>While women with chronic conditions can access a <a href="https://www.servicesaustralia.gov.au/chronic-disease-management-plan?context=20">chronic disease management plan</a>, which provides Medicare-subsidised visits to a range of allied health services (for example, physiotherapist, psychologist, dietitian), this plan only subsidises five sessions per calendar year. And the reimbursement is <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC9346321/">usually around 50% or less</a>, so there are still significant out-of-pocket costs.</p>
<p>In the case of chronic pelvic pain, the cost of accessing allied or complementary health services has been found to average <a href="https://link.springer.com/article/10.1186/s12905-022-01618-z">A$480.32 across a two-month period</a> (across both those who have a chronic disease management plan and those who don’t).</p>
<h2>More spending, less saving</h2>
<p>Womens’ health-care needs can also perpetuate financial strain beyond direct health-care costs. For example, <a href="https://www.ncbi.nlm.nih.gov/pubmed/31600241">women with endometriosis</a> and chronic pelvic pain are often caught in a cycle of needing time off from work to attend medical appointments.</p>
<p>Our <a href="https://www.researchsquare.com/article/rs-5480104/v1">preliminary research</a> has shown these repeated requests, combined with the common dismissal of symptoms associated with pelvic pain, means women sometimes face discrimination at work. This can lead to lack of career progression, underemployment, and premature retirement.</p>
<p>Similarly, with <a href="https://www.superannuation.asn.au/wp-content/uploads/2024/03/ASFAResearch_ImpactofMenopauseOnRetirement_080324.pdf">160,000 women</a> entering menopause each year in Australia (and this number expected to increase with population growth), the <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Menopause/Report/Chapter_3_-_Impact_on_work_and_the_economic_consequences_of_menopause#:%7E:text=3.1This%20chapter%20explores%20the,on%20partners%20or%20family%20members.">financial impacts</a> are substantial.</p>
<p>As many as <a href="https://www.superannuation.asn.au/wp-content/uploads/2024/03/ASFAResearch_ImpactofMenopauseOnRetirement_080324.pdf">one in four women</a> may either shift to part-time work, take time out of the workforce, or retire early due to menopause, therefore earning less and paying less into their super.</p>
<h2>How can we close this gap?</h2>
<p>Even though women are more prone to chronic conditions, until relatively recently, much of medical research has been <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC8812498/">done on men</a>. We’re only now beginning to realise important differences in how men and women experience certain conditions (such as <a href="https://www.annualreviews.org/content/journals/10.1146/annurev-neuro-092820-105941">chronic pain</a>).</p>
<p>Investing in women’s health research will be important to improve treatments so women are less burdened by chronic conditions.</p>
<p>In the 2024–25 federal budget, the government committed $160 million towards <a href="https://www.health.gov.au/ministers/the-hon-ged-kearney-mp/media/reforming-the-health-system-to-improve-sexual-and-reproductive-care">a women’s health package</a> to tackle gender bias in the health system (including cost disparities), upskill medical professionals, and improve sexual and reproductive care.</p>
<p>While this reform is welcome, continued, long-term investment into women’s health is crucial.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/243797/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p>
<p><a href="https://theconversation.com/profiles/mike-armour-391382"><em>Mike Armour</em></a><em>, Associate Professor at NICM Health Research Institute, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a>; <a href="https://theconversation.com/profiles/amelia-mardon-1505419">Amelia Mardon</a>, Postdoctoral Research Fellow in Reproductive Health, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a>; <a href="https://theconversation.com/profiles/danielle-howe-1492317">Danielle Howe</a>, PhD Candidate, NICM Health Research Institute, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a>; <a href="https://theconversation.com/profiles/hannah-adler-1533549">Hannah Adler</a>, PhD Candidate, Health Communication and Health Sociology, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>, and <a href="https://theconversation.com/profiles/michelle-oshea-457947">Michelle O'Shea</a>, Senior Lecturer, School of Business, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a></em></p>
<p><em>Image credits: Shutterstock </em></p>
<p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/women-spend-more-of-their-money-on-health-care-than-men-and-no-its-not-just-about-womens-issues-243797">original article</a>.</em></p>
</div>
