Article Examines Gender Differences in Health Care Access

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Women are more likely than men to have both health insurance and a usual source of health care but the causes of these differences are not well understood. A study in the current American Journal of Public Health concludes that, although no strong patterns were found to explain gender differences in insurance coverage and usual source of health care, differences in insurance coverage may be related to gender differences in job opportunities for men and women.

The study was based on a survey of a representative sample of nearly 700 adult residents of Central Harlem in New York City. Fifty-nine percent of respondents were women, and 84% were African American.

Women employed full time had increased odds of insurance coverage, whereas employment had no similar effect among men. Other findings include:

• 86% of women had either public or private health insurance, compared to 74% of men;



• 49% of women and 41% of men had public health insurance;



• The percentages of women and men with private health insurance were nearly equal (37% and 33%);



• 80% of women had a regular health care provider, but only 60% of men did; and



• For both men and women, having a regular source of health care was associated with higher incomes and full-time employment.

For both men and women in this study, access to insurance coverage was related to public assistance, a contrast with national studies, which have found this to be the case only for women. Socioeconomic advantage, including factors such as income, also predicted access to health care. The author wrote, "Gender differences in insurance coverage in the Harlem sample stemmed from economic barriers to employment, which give women an advantage over men, rather than greater access to public benefits among women."

Factors related to having a regular health care provider were less clear for both sexes. Nonetheless, the fact that women were more likely to have health insurance was not thought to be the cause, as this possibility was controlled for in the study.

The author acknowledges that the study's findings may be unique to the Harlem community. Other limitations of the study include the author's decision not to measure periods of no insurance coverage or of undercoverage; also, "the study predated the influence of managed care and welfare reform."

The author concludes that "expanding the availability of both public insurance and affordable private coverage for men living in low-income communities is an important means of reducing gender disparities in access to health care."

Merzel C. 2000. Gender differences in health care access indicators in an urban, low-income community. American Journal of Public Health 90(6):909-916.

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MCH Alert. 2001. Arlington, VA: National Center for Education in Maternal and Child Health. http://www.ncemch.org/alert.