Men, Women and Health Care Pricing Theory: Speaking Different Languages

flying cadeuciiMen and women in the United States think very differently about health care costs. When I talk about the topic, it’s common for me to see half of my listeners zoning out — the male half. Why? Well, because women make or influence 90 percent of the health care decisions in this country, according to a study by the American Academy of Family Physicians. Of course, men go to the doctor. But they make fewer health care decisions, and they don’t think about pricing the same way women do.

Women are more in touch with health care pricing and more affected by it than men. Women own reproductive health. Women make pediatricians’ appointments and run elder care. Women nag their spouses, be those spouses husbands or wives or none of the above, to get their cholesterol checked, to pick up a prescription, to go to that physical therapy appointment.

So when we talk about shopping for health care, about our business, we’ve grown accustomed to having dudes say “Hm, interesting, can we talk about wearable devices?” or “We have some big data, we’re not really interested in the prices.” At the same time, women tell us how excited they are that we’re attacking opacity in health care pricing.

Now don’t get me wrong: I like men. A lot. But by and large, they don’t get this issue.

Here’s some data:

  • Women make or influence 90 percent of the health care decisions in this country, according to a study by the American Academy of Family Physicians. (I’m still looking for the original to include a link, but this study is widely quoted.)
  • Women see the doctor more than men do. Women make 4.6 doctors visits a year, three times more than men do and twice as many as their children, according to a study by the Centers for Disease Control.
  • Women have a lot of purchasing power generally, as marketers know. “Reports range from $5-15 trillion, with Marketing Zeus citing sources that $7 trillion is contributed by women in the U.S. in consumer and business spending. Fleishman Hillard Inc. estimates that women will control two-thirds of the consumer wealth in the U.S. over the next 10 years,” Inside Radio reports about women and their purchasing power.

The coffee shop test: A telling example

Beyond the studies, here’s one from my personal experience: When our partners from KQED public radio in San Francisco took the embryonic version of our software to a local coffee shop to test it with real people, we had a telling series of reactions.

Lisa Pickoff-White, the KQED producer, took three sample “explanation of benefit” forms with real reports to the Starbucks, with a handful of Starbucks gift cards. She set up a sign saying “Earn a $10 gift card  testing our software.” The task was simple: use the benefits forms, put information into our PriceCheck tool, and help us learn how to make it better.

She had six men and five women volunteer. The six men, to a man, looked at the explanation of benefits and complained bitterly about it — then told her her software didn’t work.

The five women? They wrestled through the E.O.B. (yes, they’re confusing, but they can be deciphered) and input their data. Then they said, to a woman, some variation of this: “I’m so glad you are doing this — it’s really important. Let me tell you what happened to [me, my mom,  my daughter, my sister, my girlfriend] with a health care bill. Thank you for what you’re doing!”

Here’s another story from my personal experience. I was talking to married friends —  he’s a Manhattan specialist doctor and she does many things, including taking charge of  the kids’ medical events. She told of how one child needed a sleep study, so they were given equipment for an in-home test — to take home, hook up the child overnight, and then send data back to the doctor. As she described the $3,000 sleep study bill, and her fight to get it reduced to $200, he listened with amazement. This was her issue, her job — not his.

Another story: In general, I don’t spend a lot of time talking to wealthy venture capitalists (who are predominantly male) about this topic. I learned early on that I would spend a lot of time explaining the idea of an opaque marketplace and vast pricing disparities, generally to a lot of questions. But one V.C. from Palo Alto asked to meet by phone and so I agreed. His motive? He had just switched his firm from a standard insurance plan with a low deductible and low co-pay to one with a high deductible. He took  his daughter to the Palo Alto Pediatric Clinic, and got a $260-plus bill for a 15-minute visit, and wanted to tell me about it.

No, he didn’t want to invest — he was just surprised, and wanted to tell me. (Sigh.)

By and large, it’s women

Women earn less than men: an average of 79 cents for every dollar men make.  So high health costs have a disproportionate effect on women: that $1,000 medical bill for a woman is a $790 medical bill for a man. Two-thirds of minimum wage workers are women. (Related: Lower wages combined with higher health costs, as well as child care, mean that that women lose multiple opportunities to save for college, plan for retirement, buy a better car, move into a better home.)

In single-parent families, health care costs are a constant threat to economic stability. This is true not just for the poor and uninsured, but also for the middle class and the working poor – for whom a $500 or $2,000 or $6,000 deductible bill can be at the least life-changing and at the worst ruinous. As Elisabeth Rosenthal’s New York Times reporting has amply recorded, some who are now insured can’t or don’t get care because of high co-insurance and deductibles.

Women run more single-parent households, and are thus benefiting significantly from the Affordable Care Act — but one salary doesn’t go that far. “Significantly, 40 percent of working mothers with children under 18 are their families’ sole or primary breadwinners, and 83 percent of single parent families are headed by women,” a Drexel University scholar pointed out recently.

While the Affordable Care Act increased the number of insured people, “12.8 million women remain uninsured. More than a quarter (29%) of women remaining uninsured are not eligible for assistance under the ACA because they are undocumented (16%) or they fall into the Medicaid coverage gap (13%) created by their state’s decision not to expand Medicaid,” the Kaiser Family Foundation said in a report recently. Beyond that, as we now know, being insured does not protect people from ruinous bills, high co-insurance and high deductibles.

The report also said: “There is considerable state-level variation in uninsured rates across the nation, ranging from 22% of women in Texas to 5% of women in Massachusetts and Rhode Island.”

The gender lens

Beyond that, we could argue about my next statement, but experts in marketing will tell you that gender makes for a huge blind spot. “Gender is the most powerful determinant of how we see the world and everything in it,” writes Forbes contributor Bridget Brennan.  “It’s more significant than age, income, ethnicity, or geography.  Gender is often a blind spot for businesses, partially because the subject is not typically addressed in most undergraduate or graduate-level business courses, or the workplace itself.”

Of course, many men get this issue of rising health costs: My friend Chapin White at Rand, a health care economist, said he does all the health care pricing work in his family, partly because he has the expertise. e-Patient Dave deBronkart talks about it all the time, movingly. Hugo Campos, who’s known for fighting for the data from his pacemaker, gets it. Our partners at KQED public radio (hey, David Weir!) and WHYY public radio (Chris Satullo, now gone, was a huge champion). Tom Hudson and John Labonia at WLRN public radio in Miami are great supporters of our work. But they’re the exception, rather than the rule.

To be sure, many women don’t care much either: If they’re healthy, or have great insurance, or wealthy enough not to care — or for whom the problem is an abstraction. And then things change, and suddenly they care — as, for example, in this piece by Sarah Kliff of Vox about her health-care travails.

And of course, there’s this video, which never fails to worry me.

What does this mean for us, when we talk about shopping for health care? If I’m talking to a woman, she’s often informed and excited. If I’m talking to a man, I often need to explain the entire landscape, and detail who’s shopping for health care, how the marketplace works, and so on. By the time I’m done explaining the givens, our time is up and he doesn’t get it.

So what does this all add up to?

We have a wide gender disparity in people’s perceptions of our key problem. Men think no one shops for health care. Women think everyone does.

Jeanne Pinder served as an editor reporter and human resources executive at The New York Times for 23 years before leaving to found Clear Health Costs, a startup based in New York City.

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20 replies »

  1. PCOS is one of the most common causes of female infertility, affecting 20% in India. Females generally don’t openly discuss this. Myava is a community forum where females and experts share their valuable inputs with the people who join the forum.

  2. I doubt any women would out negotiate me in health care. I spent a number of years uninsured – that’s a good training ground.

  3. Thanks, Dan! We cannot fix all of the things that are broken here, but this one thing we can! and perhaps it is a fulcrum for other change!

  4. Thanks! We also have been told that one need not hold a Costco membership to use their pharmacy. But if you do have a membership, the prices are a bit lower.

    And thanks so much for the statistics below!

  5. Two of my maintenance drugs are on Tier 3 of my insurer’s formulary. The copay for a 90 day supply of a Tier 3 drug is the lesser of $100 or the insurer’s full price for the drug. I am in the process of transferring both prescriptions to Costco. Not surprisingly, the insurer makes that process as difficult as possible to minimize the loss of business. The Costco pharmacist told me it would take 30 minutes of his time on the phone with the insurer to complete their transfer process. Instead, he suggested it would be much easier for him if I could just get a new prescription from my doctor and bring it directly to Costco so that’s what I did even though I still have three 90 day renewals remaining on file with my insurer.

    The insurer’s full price and required copay for a 90 day supply of one of these two drugs is $82. Costco’s cash price is $25. The first refill pays for my annual Costco membership. At the same time, my monthly premium for my Part D plan is 78% higher than when I started on Medicare four years ago and, if anything, the coverage isn’t as good. I take some satisfaction from at least denying the insurer the profit from the two drugs I’m transferring away from them.

    One other crazy wrinkle is that Walgreens offer a drug discount membership for $20 per year for an individual and $35 for a family. The drug referred to above would cost only $20 per 90 days with the Walgreens discount card. The problem: Medicare beneficiaries aren’t eligible for it because the federal government, in its infinite wisdom, wants as many Medicare beneficiaries as possible on Part D which I’m already on. Apparently, we can’t be trusted to act in our own best interest. So it goes.

  6. Gender aside, our pricing challenges in healthcare aren’t solved by simple transparency because pricing will always be highly variable in a tiered system. Simply displaying the pricing of the various tiers does nothing to remove the tiers that are the root cause of highly variable pricing. We’ve constructed the tiers to suit a for-profit model of healthcare instead of one that’s optimized for safety and quality. We can/should change this – but pricing transparency isn’t that change.

  7. Jeanne – I don’t remember where I saw the data several years ago about male vs. female per capita healthcare spending which I believe related only to spending covered by insurers which excluded most long term custodial care spending outside of Medicaid. Here is some 2010 data which does show women spend more, especially in the 19-64 year old age group which has a lot to do with maternity benefits. The per capita numbers for the elderly seem to suggest that men spend more if you exclude nursing home care which, Medicare pays for only under very limited circumstances and Medicaid only covers after you’ve spent down your assets to almost nothing.


  8. Barry, as always, you are exceptionally wise. Also you may be the exception that proves the rule! All of your suggestions should be standard procedure. Ask “What will that cost? What will that cost me?”

    Do you have a source for that citation about women using more health care than men up to age 59-60?

    Finally, one thing about GoodRx: It never includes Costco. We talk about that and some other resources on our prescriptions page. http://clearhealthcosts.com/prescriptions/

  9. Thank you so much! What I hope and believe people will do with this information: Check your assumptions. Be mindful, and be empathetic.

    If you’re a provider, you may find a “noncompliant” patient who isn’t taking her medications because she just cannot afford them — because they’re too spendy. And yes, plans and programs should focus on the input of women.

    One of our news partners was very specific about this: He said he would never put his price information online into our community-created guide to health care prices, but his wife would. He would never “shop” for health care, but she would.

    Also, for the record: I don’t have any husbands around right now, but I raised this with a couple of friends and they laughed uproariously. “He never takes out the garbage,” one said. The other said, “As if.”

  10. I guess I’m an outlier. I go to the doctor considerably more often than my wife does as I have more significant medical issues than she does. In fact, I had an appointment this afternoon. I also care a lot about costs and have been writing about the need for both price and quality transparency in healthcare since 2006.

    I do have a few suggestions to offer that might be of help to some people. First, if you have a high deductible health plan and out-of-pocket cost is a significant issue for you, make your doctor(s) aware of that fact. There may be lower cost treatment options, including lower cost drugs that may be just as effective as the doc’s first recommendation. Second, with respect to prescription drugs, there are several iPhone apps that will tell you the cash price at pharmacies in your area. I use the Good Rx app which is very user friendly. If it’s a maintenance drug that I have to take indefinitely, I get a 90 day prescription plus three 90 day renewals so I only have to bother my doctor for a new prescription once a year. For a new drug that I wasn’t sure how long I would have to take, he gave me a prescription for a 30 day supply plus eleven 30 day renewals. If it’s an expensive drug (get the price from Good Rx), see if there is a less expensive option that you could try first. If the doctor wants to order a specific test like an MRI, get the CPT-4 code number for the procedure and call your insurer to find out what its contract rate is and your copay responsibility assuming the provider is in network. If it’s not in network, it’s better to know that ahead of time.

    I don’t have to deal with these issues anymore because I have FFS Medicare plus a comprehensive supplemental plan. I joke though that it costs my wife and me a lot of money to make healthcare feel free at the point of service.

    For the record, I’ve read that women use more healthcare than men do up until about age 59-60. After that, men use more. For those of us who have chronic conditions, it’s not hard to get us to go to the doctor if we’re interested in staying alive. Those chronic diseases and conditions account for over 80% of healthcare costs including virtually all of my own medical claims.

  11. After I got over feeling slightly insulted, I realized that you’re quite correct on the issue of gender focus. Ask any male who returns home after an annual physical and has to face the questions his wife asks him and that he, of course, didn’t ask the doc (and after she gave him a list which he ignored). And we know–I’m not making this up. Women ARE more focused on healthcare. They do make most of the family healthcare choices, and drive the decisions to get healthcare. As to its costs, I must admit I’m a little surprised there’s such a gender gap.

    But OK, so what do we do with that information? While I was entertained, I want to know how I can use that information. Does this mean we should design plans and programs primarily based on female input since mostly women will be using them? Sounds like that would be smart. I enjoyed your article.

    And for the record: we men always take out the garbage.

  12. “Women make 4.6 doctors visits a year, three times more than men do and twice as many as their children,”

    No wonder health care is so expensive. Back off girls it may get better on its own.

    “As she described the $3,000 sleep study bill, and her fight to get it reduced to $200, he listened with amazement. This was her issue, her job — not his.”

    This is counter to every other purchasing decision. Women don’t negotiate in general and that’s why they pay more than men on average.

  13. Ah yes. Reinforces my view that the only way forward is full-on transparency. Also that good journalism is crucial at this point.

  14. You are so funny! I think your “I don’t get it” statement is at the heart of the issue.

    Built by men, used by women.

    Who pays him the extra dime, or dollar, or thousand dollars? It’s her.

  15. You would be proud of me, Jeanne.

    My primitive male brain sat up and paid attention when I read this.

    This makes a lot of sense to me.

    The reaction from venture capitalists is interesting ..

    If you don’t mind me asking, I’m thinking you’re getting a lot of “I don’t get it. You want to save money? We want to make money.”

    (I get the theory of how it works. But I’d love to be a fly on the wall for that conversation.

    / j

  16. True. But for some people it’s been a lifesaver, literally.

  17. ” Beyond that, as we now know, being insured does not protect people from ruinous bills, high co-insurance and high deductibles.”

    Nor does it ensure medical care and treatment. I think many could have told you this when the ACA was being formulated, men and women.