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The pink tax (which refers to gender-based discrepancies in the pricing of products and services) is not relegated to the drugstore aisles. There also happens to be a pink tax on women’s time—they tend to have less of it since more hours are devoted to caretaking and household chores than their male counterparts—and we’re now seeing the reverberations when it comes to their health care.
Women are this country’s core health care customers, spending significantly more than men: According to a fall research report by Deloitte, it’s approximately $15 billion more a year. At Parsley Health, a holistic medical practice founded by Robin Berzin, MD, in 2016, women comprise the majority (around 80%) of the patient base. But looking at the discrepancies in women’s spending on health care, Dr. Berzin wondered how their experience of it actually was. That question became the impetus for a far-reaching survey Parsley Health recently commissioned among workforce-age women (between 18 to 60), the results of which reveal some staggering truths about the vast gap between spending and actual care.
Dr. Berzin was astounded by how many women felt both like they didn’t have a clear diagnosis for what was ailing them (67%) and that they were dismissed by their health care provider: 50% said they were quickly prescribed Band-Aid medication without getting to a root cause.
And this statistic will be unsurprising to many women: 15% had previously been told their complaints were all in their heads. “One of the biggest areas we saw with this survey is just how much women are not heard, dismissed, and gaslit,” says Dr. Berzin. And how much women have been culturally conditioned into thinking that there is nothing out of the ordinary about feeling unwell. “Women are living with these symptoms—they’re bloated and exhausted and brain fogged and have joint pain and headaches—because they think it’s normal.”
Dr. Berzin, who still sees patients at Parsley as well, says that many women come in swarming with symptoms but with no diagnosis: Autoimmune disease, which is skewed 80% to women, can take an average of five years to be diagnosed. And many women, says Dr. Berzin, present with undiagnosed thyroid conditions. (One in five women will be diagnosed in their lifetime.) Their symptoms (like weight gain, depression, high cholesterol, sluggish GI tract, and feeling cold) often prompted previous doctors to quickly put them on antidepressants and blood-pressure meds without proper testing, and some had even developed secondary GI issues because their thyroid wasn’t treated.
But the most staggering takeaway from the Parsley survey was that 80% of women were simply delaying medical care. “The reasons were time poverty and feeling like they were going to go to the doctor and basically just be dismissed, handed a pill, and shuffled out the door not getting what they need,” says Dr. Berzin. “And the third was cost.”
A recent Deloitte consumer survey supported those findings, with one in five women saying they decided not to see a doctor when sick because of cost and one in seven delaying follow-up care because of cost. And its fall research report (aptly titled “Hiding in plain sight: The health care gender toll”) delved further into gender-based pricing discrepancies and found that women are paying significantly more in out-of-pocket health care costs: $15.4 billion more a year, a disparity that persists even when you take out all the charges related to pregnancy.
“The value that we get for a dollar is less than the value that men get,” says Kulleni Gebreyes, MD, Deloitte’s US consulting health care sector leader and US chief health equity officer, who started out her career in public health and as an ER doctor. “We’re paying more for the services that we get because we use health care differently.” Women often don’t reach their out-of-pocket mark, and the services they need require more co-pays, so they end up paying the same amount for premiums as men but getting less value, even though they use certain health care services—like radiology, physical and occupational therapy, emergency-room visits, and mental health services—more than men.
One common gap in spending is around breast cancer screenings. Your initial preventive screening is covered, but, says Dr. Gebreyes, many women’s medical needs require additional tests. “Research shows that one in 10 women will have an abnormal initial diagnostic mammogram,” says Dr. Gebreyes. “The way that cost sharing is designed, once you’re that one out of 10 women, your costs skyrocket because then you need an ultrasound or a biopsy or an MRI, and all of these are additional co-pays.” What if insurance costs were designed not as one-size-fits-all but with women’s biological and physiological needs in mind, Dr. Gebreyes posits. “For example, an insurance company could create an episode of care that once you have an abnormal test, your co-pays are a single amount as opposed to being à la carte, where you’re paying for every single thing until you get to the final answer,” she adds.
To begin to close some of these gaps, Deloitte in its report suggested employers look at how they design their benefits and what the value is of the care women are getting, and lower the cost sharing of services that women use with more frequency. Meanwhile, Parsley Health is increasing the number of major employers it’s working with so it can make its holistic-care model more accessible. “In both the medical world and our culture at large, we’ve all been trained to not go to the doctor until you’re really sick,” says Dr. Berzin. “It should be in the health care system’s interest to be more proactive about health.”
In the meantime, though, it’s on women to be proactive both about seeking out care when they need it and evaluating how that care is covered. Now, about that tax on women’s time….
