Chronic care access limits diagnosis & quality for women

March 27, 2024 - It could take more than a year longer for women to get a diagnosis for a chronic disease than it could for their male counterparts, with new survey data showing stark disparities in how women rate their chronic disease care.

The State of Patient Access report from the PAN Foundation found that it typically takes women 3.9 years to get a diagnosis for a chronic illness. For men, that figure is 2.4 years.

“Our 2024 State of Patient Access Report spotlights the all-too-common challenges facing patients with chronic disease in accessing needed healthcare—from insurance barriers to medication costs,” Amy Niles, chief mission officer at the PAN Foundation, said in an emailed press release.

“We know disparities in healthcare are rooted in racism, bias, structural inequities, social and economic disadvantages, and inefficiencies in the healthcare system,” Niles continued. “To bring about needed change, key stakeholders need to shape an action-oriented policy agenda that chips away at these deep systemic flaws and expands access to affordable, equitable care. We must also educate policymakers about these issues and encourage them to enact meaningful policies that improve healthcare access.”

The report details a survey of chronically ill patients conducted by Harris Poll, revealing that the state of healthcare access is generally substandard, regardless of gender. Measured across five domains—overall access to care, relationships with healthcare providers, affordability of prescription medications, access to treatment through health plans, and financial toxicity—respondents gave their overall healthcare access a 75.8 out of 100, considered a C grade.

Some domains are better than others. Patients rated their patient-provider relationships a B, getting a score of 84.2, and prescription drug affordability a B-, with a score of 82.3

But overall access to care was a C+ (78.8), and financial toxicity was a C- (70.7). Scores for access to treatment through a healthcare plan were abysmal, garnering a score of 62.8, or a D-.

Broken down by demographic, the researchers observed steep differences.

For example, women are less likely to give a high rating than their male counterparts. Their overall grade for their healthcare was similar, with the access to treatment through healthcare plans dragging their overall grade down by a few tenths of a point.

But digging deeper, there were serious differences in how women get a chronic disease diagnosis. Not only can it take more than a year longer for them to get a diagnosis, but women were also more likely than men to describe their diagnostic process as difficult (37 percent versus 28 percent). About one in five (19 percent) women said the quality of care they received in the past year was fair or poor, compared to 14 percent of men.

Women are also more likely than men to experience a great deal or a lot of financial toxicity due to their illnesses, shaking out to 26 and 20 percent reporting as much, respectively.

Unexpected medical bills, in particular, hamstring women, with 56 percent saying bills were not at all or not very affordable and 28 percent saying they were completely unaffordable. For men, that figure was 45 percent.

An unexpected medical bill is more likely to harm a woman’s finances than a man’s, with 56 percent saying they could only manage an unexpected medical bill of up to $500, while 39 percent of men said the same.

This translates into a latent worry for women, with 48 percent of those surveyed saying they worry about medical bills for the coming year, compared to 42 percent of men who said the same.

Other traditionally underserved demographics also disproportionately suffered. While 48 percent of patients surveyed reported logistical barriers to care, this was more common for patients of color (57 percent), younger patients (70 percent of Gen Z and Millennial patients), and LGBTQIA+ patients (77 percent).

Moreover, Hispanic, Native American or Pacific Islander, and LGBTQIA+ patients were more likely to report challenges affording their prescription medications as well as accessing treatment through their health insurance.

For Hispanic, Native American or Pacific Islander, and LGBTQIA+ patients, this domain received an F grade. Specifically, affordability of deductibles, limits in accessing prescriptions, and carrying a fear that their insurance could make it harder to access prescriptions weighed heavily.

Notably, affordability woes affected patients on private and public insurance in equal measure, with around a fifth of patients reporting financial toxicity regardless of insurance type. This indicates that insurance type cannot insulate chronically ill patients from the high healthcare costs likely to come their way.