Summary: Men 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.
People: Women know the prices, even if guys don’t. (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.”
[Update, June 10, 2016: “In aggregate, female spending was $1,231 billion and accounted for 56 percent of total personal health care (PHC) spending (females accounted for just over 50 percent of the population). Male spending was $962 billion and accounted for the remaining 44 percent,” the Center for Medicare and Medicaid Services reported in a study of 2010 spending, the most recent I could find. “Per capita health spending for females was $7,860, 25 percent more than that for males, $6,313. In aggregate, female spending was higher than male spending for every category of PHC goods and services. … Females between ages 19-44 spent 70 percent more per capita than did males in the same age-group. This is the largest difference measured of any age-group, largely due to the costs associated with maternity care.”)
(Update, June 15, 2016: For more data, see the attached .pdf fact sheet from the Department of Health and Human Services, or go to this link. Update, June 16, 2016: Of course, I’m not the only person to have noticed this. This Harvard Business Review piece explores some of the same issues. It refers to this larger study of the topic. Update, June 26: Here’s a piece about “a closed loop of white guys talking to other white guys about other white guys” — in this case, in the ad industry.]
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. So do 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.