Both sexes delay care, just not the same care

Ann Carrns / New York Times News Service /


Published Sep 7, 2013 at 05:00AM / Updated Nov 19, 2013 at 12:31AM

Here’s a situation that may sound familiar: A man visits his doctor’s office with his wife, who laments how stubborn he is about seeking medical care.

Frank Wharam, a doctor and researcher at Harvard Medical School, says he often hears these words, “My wife made me come.”

That gender dynamic may provide fodder for stand-up comics, but it can have serious health implications, especially given the increasing use of high-deductible health insurance plans.

Men, it turns out, are more likely to delay treatment for serious conditions under high-deductible plans, in contrast to women, who tend to be more selective and cut back care for minor ailments only.

That’s according to a recent study led by Katy Kozhimannil, a researcher at the University of Minnesota’s school of public health. (Wharam was a co-author.)

Such plans generally have lower monthly premiums than traditional health plans but higher out-of-pocket costs — sometimes, $4,000 or $5,000 for a family, or even higher. About a third of workers now have such plans.

And that number is likely to grow, since lower-cost plans on the new health care marketplaces created by the Affordable Care Act are likely to have relatively high deductibles.

Other studies have shown that low-income people also tend to put off care under such plans. But Kozhimannil says her study is the first to examine the different impact of such plans on men and women.

In the ER

The study compared emergency room visits for about 12,000 people — roughly half men and half women — for a year before, and two years after, they were involuntarily switched by their employers to a high-deductible plan.

For the first year after the switch, men’s use of the ER dropped across the board, even for severe conditions, like irregular heartbeat. Women cut back too, but mostly for less threatening symptoms, like headaches or sore throats.

“It’s concerning that men were not going to the ER” for ailments like kidney stones and irregular heartbeats, Kozhimannil said. “That’s an urgent situation that requires medical care.”

Unfortunately, men also ended up with more hospitalizations in subsequent years, suggesting that they may have let a serious condition go untreated.