View
0
Download
0
Category
Preview:
Citation preview
Women’s Health Care Chartbook
Key Findings from the
MAY 2011
Kaiser Women’s Health Survey
Women’s Health Care Chartbook
Key Findings from the
Usha Ranji, M.S.Alina Salganico�, Ph.D.
Kaiser Family Foundation
Kaiser Women’s Health Survey
MAY 2011
Acknowledgements
the authors thank mary mcIntosh and her colleagues of Princeton survey Research Associates International as well as mollyann Brodie, Heidi Hisey and esme cullen of the kaiser Family Foundation for assistance with the kaiser women’s Health survey and preparation of this report.
�
Table of ConTenTs
lIst oF exHIBIts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii
IntRoductIon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
cHAPteR 1: Profile of women’s Health . . . . . . . . . . . . . . . . . . . . . . . . .5
cHAPteR 2: Health coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
cHAPteR 3: delivery system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
cHAPteR 4: Prevention and screening . . . . . . . . . . . . . . . . . . . . . . . . . 23
cHAPteR 5: Access and Affordability . . . . . . . . . . . . . . . . . . . . . . . . . . 29
cHAPteR 6: work, Family, and caregiving . . . . . . . . . . . . . . . . . . . . . . . 35
metHods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
��
���
lIsT of eXHIbITs
CHapTer 1: profile of Women’s Health
exHIBIt 1a Health status Indicators by Poverty level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
exHIBIt 1b Health status Indicators, by Age group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
exHIBIt 1c Health status Indicators, by Race/ethnicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
exHIBIt 1d chronic Health conditions, by selected characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
exHIBIt 1e depression and Anxiety, by selected characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
exHIBIt 1f sources of stress, by Health status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
CHapTer 2: Health Coverage
exHIBIt 2a women’s Health Insurance coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
exHIBIt 2b characteristics of women, by type of Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
exHIBIt 2c duration of lack of Health Insurance coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
exHIBIt 2d growth in long-term uninsured . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
exHIBIt 2e uninsured Rate by selected characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
exHIBIt 2f Health Insurance coverage, by Poverty level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
exHIBIt 2g Health Insurance coverage, by Race/ethnicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
CHapTer 3: Delivery system
exHIBIt 3a women with a Regular Health care Provider, by selected characteristics . . . . . . . . . . . . . . . . . . 16
exHIBIt 3b number of Providers women see . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
exHIBIt 3c Provider specialties, by Age group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
�v
lIsT of eXHIbITs (continued)
CHapTer 3: Delivery system (continued)
exHIBIt 3d Provider Visit in Past Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
exHIBIt 3e use of gynecological care, by selected characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
exHIBIt 3f Access to specialists, by selected characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
exHIBIt 3g worsening Access to specialty care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
exHIBIt 3h use of mental Health care, by selected characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
exHIBIt 3i concerns About Quality of care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
exHIBIt 3j sources of Health Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
exHIBIt 3k sources of Health Information, by Age group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
CHapTer 4: prevention and screening
exHIBIt 4a screening tests, by selected characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
exHIBIt 4b counseling About Health Behaviors, by Age group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
exHIBIt 4c growing Attention to obesity and Related conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
exHIBIt 4d counseling About sexual Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
exHIBIt 4e HIV and std testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
exHIBIt 4f sources of Information on HPV Vaccine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
CHapTer 5: access and affordability
exHIBIt 5a delayed or went without care Because of cost, by Poverty and Insurance status . . . . . . . . . . . . . 30
exHIBIt 5b delayed or went without care Because of cost, by selected characteristics . . . . . . . . . . . . . . . . 30
v
lIsT of eXHIbITs (continued)
CHapTer 5: access and affordability (continued)
exHIBIt 5c more evidence of tradeoffs to Pay for Health care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
exHIBIt 5d Financial tradeoffs to Pay for Health care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
exHIBIt 5e Reasons for delaying or going without care, by Poverty level . . . . . . . . . . . . . . . . . . . . . . . . . 32
exHIBIt 5f use of Prescription drugs, by selected characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
exHIBIt 5g number of Prescription drugs, by Age and Health status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
exHIBIt 5h Prescription drug costs, by selected characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
exHIBIt 5i Prescription drug costs, by Insurance status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
CHapTer 6: Work, family, and Caregiving
exHIBIt 6a characteristics of mothers and guardians of dependent children . . . . . . . . . . . . . . . . . . . . . . . 36
exHIBIt 6b caring for children’s Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
exHIBIt 6c Impact of Family Health Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
exHIBIt 6d workplace Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
exHIBIt 6e Flexibility in work day . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
exHIBIt 6f Profile of Family caregivers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
exHIBIt 6g Impact of caregiver Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
MeTHoDs
FIguRe A selected demographic characteristics of women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
FIguRe B selected socio-economic characteristics of women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
KeyFindingsFromtheKaiserWomen’shealthsurvey �
InTroDuCTIon
healthcarehaslongbeenapr�or�ty�ssueforwomen,andwomen’shealthandaccesstocarewerecentral�ssues�ntheleaduptothepassageofthenewhealthreformlaw .healthcare�sacentralelementofwomen’sl�ves,shap�ngthe�rab�l�tytocareforthemselvesandthe�rfam�l�es,tobeproduct�vemembersofthe�rcommun�t�es,contr�butetotheworkforce,andtobu�ldabaseofeconom�csecur�ty .Wh�lethefinalhealthreformleg�slat�onencompassedabroadrangeofareas,severalofthe�ssues�mportanttowomen–accesstocoverage,affordab�l�ty,andqual�tyofhealthcareserv�ces–werekeyconcernsfromtheoutset .
thedata�nth�schartbookdescr�behowwomenarefar�ng�nthehealthcaresystem,andw�llprov�deausefulbasel�neofunderstand�ngwomen’sexper�encesasthehealthreform�mplementat�onmovesforward .thesedataalsoh�ghl�ghtd�fferences�nexper�encebetweenvar�oussubgroupsofwomen,part�cularlythosewhoareatr�skforpooraccesstocare,thosewhoarelow-�ncome,andwomenofcolor .
thedatapresented�nth�sWomen’s Health Care Chartbookarebasedonanat�onallyrepresentat�vesurveyof2,0�5womenages�8to64�nterv�ewedbytelephone�nthespr�ngandsummerof2008 .th�ssurveybu�ldsonpr�orKa�serFam�lyFoundat�onsurveysonwomen’shealth,conducted�n200�and2004,whentheeconomywasmuchstronger .th�ssurveywasconducted�ntheearlydaysoftherecess�on�n2008,andeconom�ccond�t�onshavebecomemuchworses�ncethedatawerecollected .
th�schartbookprov�desthelatestdataonmajorareasofwomen’shealthpol�cy,�nclud�ngwomen’shealthstatus,�nsurancecoverage,the�r�nteract�onw�ththehealthcaredel�verysystem,useofprevent�veserv�ces,accesstocare,andworkandfam�lyhealth�ssues .acrossalloftheseareas,severalkeyfind�ngshaveemerged:
WoMen’s HealTH sTaTus
while most women in the u.s. enjoy good health, one third report that they live with a chronic health problem and one in four report depression or anxiety. As women age, they are more likely to experience chronic health problems and report fair or poor health.
n e�ght�n�0womenbetween�8and64reportexcellent,verygood,orgoodhealth .however,as�zablem�nor�ty—nearlyone�nfive(�8%)—are�nfa�rorpoorhealth,wh�ch�sagoodpred�ctorofneedforhealthcareserv�ces .th�sproport�on�ncreasesw�thage,tooverone-quarter(29%)ofwomenages50to64report�ngfa�rorpoorhealth .
n morethanone-th�rdofwomen(35%),haveachron�ccond�t�onthatrequ�resongo�ngmed�calattent�on,suchasd�abetesorhypertens�on .evenamongyoungerwomen,approx�matelyone�n�0womenofreproduct�veage(�8to44years)saytheyhavebeend�agnosedw�tharthr�t�s(9%),hypertens�on(��%),orh�ghcholesterol(9%),andbythet�mewomenreachthe�rm�ddleyears(45to64years),theseratestr�pleto39%,36%,and34%respect�vely .
women of color and low-income women are more likely to report health problems than higher income or white women.
n Poorwomen(33%)arethreet�mesasl�kelyaswomen�ntheh�ghest�ncomegroup(��%)toratethe�roverallhealthasfa�rorpoor .afr�canamer�canwomenhaveh�gherratesofseveralchron�ccond�t�ons,comparedtoWh�teandlat�nawomen,�nclud�ngarthr�t�s,hypertens�on,andheartd�sease .
A sizable minority of women report experiencing high levels of stress attributable to economic, health, or work related concerns. one in four women have struggled with depression or anxiety in the past five years.
n manywomenfeelheavystressfromarangeofhealth,econom�c,andfam�ly�ssues,�nclud�nghealthproblemsofthe�rfam�lymembers,financ�alconcerns,andcareerchallenges .approx�matelyaquarterofwomenreportfeel�ngh�ghlevelsofstressfromcareer(23%)andfinanc�alconcerns(26%) .however,thesepressuresareevenworseforwomen�npoorerhealth,whoaretwotothreet�mesasl�kelytoexper�enceheavystressfromthese�ssueswhencomparedtowomen�nmorefavorablehealthstatus .
n mentalhealth�sanoftenoverlookedbutcr�t�calaspectofwomen’shealthcare .oneoutofeveryfourwomen(26%)reporttheyhavebeend�agnosedw�thdepress�onoranx�ety�nthepastfiveyears .lower-�ncomewomen,�npart�cular,aremorel�kely(34%)toexper�encedepress�on/anx�etycomparedtowomenw�thh�gher�ncomes(23%) .
2 Women’shealthCareChartbooK
introduCtion
HealTH Coverage
most adult women have some form of either private or public health insurance, but nearly one quarter are either currently uninsured or were uninsured for part of the prior year.
n employer-sponsored�nsurance�sthelead�ngformofcoverageforwomen,cover�ng6�%ofwomene�therthroughthe�rownjoborasadependent .s�xpercentofwomenpurchase�nd�v�dual�nsurancepol�c�es,�0%arecoveredthroughmed�ca�d,thehealthprogramforlow-�ncome�nd�v�duals,andanother6%havee�thermed�careorsomeotherformofcoverage,suchasm�l�tarybenefits .desp�teth�spatchworkof�nsurancetypes,�7%ofwomenages�8to64areun�nsured .
n lower-�ncomewomenandwomenofcolorareatgreaterr�skforbe�ngun�nsured,asarewomenwhoares�ngle,young,and�nfa�rorpoorhealth .thesegroupsofwomentendtohavelowerratesofemployer-sponsoredcoverageandarealsomorerel�antonthemed�ca�dprogramthanthe�rcounterparts .
n inadd�t�ontothe�7%ofwomencurrentlyw�thout�nsurance,another7%ofwomenreportbe�ngun�nsuredearl�er�ntheyear .
the share of women who are uninsured for extended periods of time is growing.
n manyun�nsuredwomenarerema�n�ngw�thoutcoverageforlongerper�odsoft�me .in2008,morethanaquarter(27%)ofun�nsuredwomenhadbeenw�thoutcoverageforatleastfouryears,comparedto20%ofun�nsuredwomen�n2004,whentheeconomywasstronger .
InTeraCTIons WITH THe HealTH Care DelIvery sysTeM
A sizable minority of women report problems with access to primary and specialty care and have concerns about the quality of care they receive. these problems are greatest for, but not limited to, uninsured women.
n mostwomen(83%)reportthattheyhaveaprov�dertheyseeonaregularbas�s .th�s�ncreasesw�thage,from77%ofwomenages�8to44to90%ofwomen45to64 .
n however,somegroupsofwomenhavealessstablerelat�onsh�pw�ththehealthcaresystemandlackausualsourceofcare .onlytwo-th�rdsoflat�nas(67%)havearegularprov�der,muchlowerthanWh�te(86%)andafr�canamer�can(84%)women .un�nsuredwomenarepart�cularlyatad�sadvantage,w�thlessthanhalf(47%)hav�ngth�sv�tall�nktothehealthcaresystem .
many women have two or more regular providers, typically a primary care provider and an ob-gyn.
n Formostwomenw�tharegularprov�der,thespec�altyofthe�rregularprov�der�sfam�lymed�c�neor�nternalmed�c�ne .aboutone�n�0womensaythe�rregularhealthprov�der�sanursepract�t�oneroraphys�c�an’sass�stant .overfour�n�0women(44%),reportthattheyhavetwoormoreregularprov�ders .
n twoth�rdsofwomenreportedthattheyhadhadatleastoneob-gynv�s�t�nthepastyear,morecommonamongyoungerwomen�nthe�rreproduct�veyears .
many low-income and uninsured women have not had a recent health care visit.
n aprov�derv�s�t�nthepastyear�softencons�deredanother�nd�catorofaccesstothehealthcaresystem .aga�n,un�nsuredwomenaretheleastl�kelytohavehadaprov�derv�s�t�nthepastyear(67%),comparedtowomenw�the�therpr�vate(90%)orpubl�c�nsurance(med�ca�d(89%)andmed�care(96%) .
n lat�nawomen(80%)ares�gn�ficantlylessl�kelytoreportamed�calv�s�t�nthepastyearcomparedtoafr�canamer�can(88%)andWh�te(87%)women .
Access to specialty care is a problem for many women, but particularly for those who are uninsured or in fair or poor health. Access to specialty care is also worsening over time.
n manywomenrequ�recarefrommed�calspec�al�stsandarenotabletoga�naccesstotheseprov�ders .therearelarged�fferencesby�nsuranceandhealthstatus .Wh�le�2%ofwomenw�thpr�vate�nsurancestatethattheywerenotabletoseeaspec�al�stwhenneeded,theproblem�sfarworseforwomenonmed�ca�d(30%)andthosew�thout�nsurance(43%) .
KeyFindingsFromtheKaiserWomen’shealthsurvey 3
introduCtion
n Comparedtowomen�nfavorablehealth(�5%),women�npoorerhealth(42%)arealmostthreet�mesasl�kelytoreporttheycouldn’tgetaccesstospec�altymed�calcaretheythoughttheyneeded,poss�blyexacerbat�ngex�st�nghealthproblems .
n overt�me,accesstospec�al�stshasworsenedforwomen,w�thone-fifth(2�%)ofwomenreport�ngtheycouldnotseeaspec�al�stby2008,comparedto�6%justfouryearsearl�er .
Quality of care is a concern for one in four women.
n Concernsaboutqual�tywerepart�cularlycommonamongwomen�nfa�rorpoorhealth(42%)comparedto22%ofwomen�nbetterhealth .
n as�zablem�nor�tyoflow-�ncome(32%)orun�nsured(39%)reportedqual�tyconcernsaswellasthoseonmed�ca�d(28%)andmed�care(30%) .Womenofcoloralsoaremorel�kelytoexpressconcernsaboutqual�tyofcarethanWh�tewomen .
while there has been a rapid proliferation of health information through the internet, health providers are still the leading source of health information for women.
n overfour�ntenwomen(44%)reportturn�ngtothe�rprov�derfirstwhenseek�ng�nformat�ononahealth�ssue .
n Wh�lehealthcareprov�dersarethelead�ngsourceof�nformat�onforwomenofallages,therearegenerat�onald�fferences,w�thmanyyoungerwomenalsoseek�ng�nformat�ononl�neandfromfam�lyandfr�ends,w�tholderwomenmorel�kelytoseek�nformat�onfromprov�dersfirst .
prevenTIon anD sCreenIng
despite growing attention to the important role of early intervention and healthy behaviors in health promotion and disease prevention, use of preventive counseling and screening services still fall far below recommended levels.
n two-th�rdsofwomen(67%)saytheyhaved�scussedd�et,exerc�se,andnutr�t�onw�thadoctorornursedur�ngthepastthreeyears .
n Fewerthanhalfofallwomenreporthav�nghadrecentconversat�onsaboutotherhealthbehav�ors,suchascalc�um�ntake(44%),smok�ng(35%),andalcoholuse(25%) .
n Comparedtowomenw�th�nsurance,un�nsuredwomencons�stentlyreportlowerratesofscreen�ngtestsformanycond�t�ons,�nclud�ngbreastcancer,cerv�calcancer,h�ghbloodpressure,andh�ghcholesterol .
n thereseemstobegrow�ngattent�ontounderly�ngcausesofchron�cd�seases,suchasd�et,exerc�se,andh�ghcholesterol .almosthalf(49%)ofwomensa�dtheyhadtalkedw�thaprov�deraboutd�etandexerc�se�nthepastyear,comparedtojust39%�n2004 .overs�x�nten(63%)womenreportedhav�ngarecentcholesteroltest�n2008,upfrom56%�n200� .
counseling and screening services that address women’s sexual health are infrequent, especially considering the negative impact of sexually transmitted diseases, unintended pregnancy and violence on women’s health and well being.
n only38%ofwomenages�8to44saythattheyhavetalkedw�thaprov�deraboutthe�rsexualh�story�nthepastthreeyears .d�scuss�onofmorespec�fictop�cs,suchasstds(28%),hiv/aids(29%)anddomest�cordat�ngv�olence(�5%)areevenlessfrequent�nthecl�n�calsett�ng .
n th�rtypercentofwomenages�8to49reportthattheyhavebeentestedforanstd�nthepasttwoyears,but35%ofthesewomenwereerroneouslyunderthe�mpress�onthatstdtest�ngwasarout�nepartofacl�n�calexam .
n thestory�ss�m�larforhivtest�ng,butthere�sgreateruncerta�nty .th�rty-s�xpercentofwomen�8to49reportedhav�nganhivtest�nthepasttwoyears,butmorethanhalf(54%)assumed�twasarout�nepartofanexam,wh�ch�snottyp�callythecase .
n oneofthenewestprevent�vetechnolog�es�sthedevelopmentofvacc�nesaga�nsthPv,thev�rusrespons�bleformostcasesofcerv�calcancer .mostwomenhadheardoftherelat�velynewvacc�ne,howevermostreport(62%)thattheylearnedabout�tfromadvert�sementssuchastelev�s�oncommerc�als,notfromamed�calprov�der(20%) .
4 Women’shealthCareChartbooK
introduCtion
aCCess anD afforDabIlITy
Health care costs pose a barrier to health care and prescription drugs for many women.
n one-quarterofnon-elderlywomen(24%)wentw�thoutordelayedneededcarebecausetheycouldnotaffordthecosts .Costsweremorefrequentlyreportedtobeaproblemforwomenw�thout�nsurance(55%)andthosel�v�ngbelowthepovertyl�ne(46%) .
n insuredwomenalsofacecostrelatedbarr�erstocare .one�nsevenwomenw�thpr�vatecoverage(�4%)andalmostone-th�rdofwomenw�thmed�ca�d(3�%)statedthattheypostponedorwentw�thoutneededserv�ces�nthepastyearbecausetheycouldnotafford�t .
n halfofallwomenuseatleastoneprescr�pt�ondrug(5�%)onaregularbas�s .therate�sh�gherforwomenages45to64(63%)comparedtoyoungerwomenages�8to44(42%) .thenumberofprescr�pt�onsalsor�sesw�thage,w�thnearlyaquarterofwomenages45to64(23%)tak�ngatleasts�xmed�cat�onsregularly,comparedtojust4%ofyoungerwomen�nthe�rreproduct�veyears .
n manywomencannotaffordtofillthe�rprescr�pt�ons .theye�therdonotfillprescr�pt�ons(23%)orresorttosk�pp�ngdosesandspl�tt�ngp�lls(�8%) .theseproblemsdonotjustaffectun�nsuredwomen,butarealsoreportedbyas�gn�ficantshareofwomenw�thpr�vatehealthcoveragewhomayhaved�fficultyafford�ngcopaysfordrugs .
Barriers to health care intersect with many other facets of women’s lives.
n increas�ngsharesofwomenaredeal�ngw�thhealthcarecostpressuresbymak�ngtradeoffsw�thotherexpenses .between2004and2008,theshareofwomenreport�ngtheyhadtospendlessonotherbas�cneedstopayforhealthcaredoubledfrom8%to�6% .thedualpressuresof�ncreas�nghealthcarecostsandtherecess�onhavel�kelystra�nedmanywomenandaffectedthe�rab�l�tytomakeendsmeetandpayforcare .
n Womenalsodelaycareforreasonsbes�descosts .transportat�onproblems(8%),lackofch�ldcare(�3%),andl�m�tedt�meofffromwork(�8%)forcemanywomentopostponeorgow�thoutcare,andtheseproblemsaremorecommonamongwomenwhoarelow-�ncome .
Work, faMIly, anD CaregIvIng
women are the primary managers of their children’s care and for mothers who also work, this responsibility has consequences for their work and economic wellbeing.
n morethane�ght�n�0mothers/guard�anssaytheytakeonch�efrespons�b�l�tyforchoos�ngthe�rch�ldren’sdoctors(85%),tak�ngthemtoappo�ntments(84%),andensur�ngtheyrece�vefollow-upcare(79%) .
n asthepr�marycoord�natorsofhealthcareforthe�rch�ldren,manywork�ngmothers(48%)musttaket�meoffwhenthe�rch�ldrengets�ck .however,ontopofshoulder�ngpr�maryrespons�b�l�tyforcar�ngfors�ckch�ldren,abouthalf(47%)ofwomenwhodon’thavech�ldcarealternat�veslosepaywhentheystayhometocareforas�ckch�ld .
n balanc�ngworkandfam�lycanbeanongo�ngchallengeformanywomen,but�tcanbepart�cularlyd�fficultforlower-�ncomewomenwhohavefewerworkplacebenefits .lessthanhalfoflow-�ncomewomenhavepa�ds�ckleave(45%),comparedto69%ofh�gher�ncomewomen .lessthanhalfalsohaved�sab�l�ty�nsurance(42%)oraret�rementplan(44%) .
women play a central role in providing care for chronically ill or disabled family members.
n overone�n�0women(�2%),caresforas�ckorag�ngrelat�ve,oftenan�llparent .thesewomenmustalsocontendw�thahostofthe�rownhealthchallenges .one�nfiveareun�nsured,half(5�%)haveachron�chealthcond�t�onofthe�rown,and28%ratethe�rhealthasfa�rorpoor .
n aboutone�nfive(�9%)careg�versprov�desfull-t�meass�stancetofam�lymembers(morethan40hoursperweek),theequ�valentofafull-t�mejob .Prov�d�ngth�scarestra�nsthefinancesofone�nfive(2�%)careg�versaswellcreatesh�ghlevelsofstressforoneth�rdofth�sgroup .
CHAPTER 1:
Profile of Women’s Health
6 Women’shealthCareChartbooK
ChaPter�:ProfileofWomen’shealth
alargebodyofresearchhasdocumentedtherelat�onsh�poflow-�ncometopoorerhealth .Womenw�th�ncomeslessthan�00%ofthefederalpovertythresholdarethreet�mesasl�kely(33%vs .��%)toassessthe�rhealthstatusasfa�rorpoorthanthe�rh�gher�ncomecounterparts(300%ofthepovertylevelorgreater) .s�m�larly,therateofd�sabl�ngcond�t�ons�sovertw�ceash�ghamongpoorwomen .approx�mately,oneth�rdofwomenofall�ncomesreportedtheyhadachron�ccond�t�onthatrequ�resongo�ngtreatment .thes�m�lar�ty�ntheratescouldbeattr�butabletolackofaccesstocare,result�ng�nlowerratesof�dent�ficat�onofchron�chealthproblemsamongpoorerwomen .
exHIBIt 1a
Health status Indicators by poverty level
note:thefederalpovertythresholdwas$�7,600forafam�lyofthree�n2008 .source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
All WomenLess than 100% of poverty 100 to 199% of poverty
200 to 299% of poverty 300% of poverty and higher
Percentage of women ages 18 to 64 reporting: 39%
35%33%
22%
34%
19% 20%
30%
38%
18%14%
17%14%
11% 9%
Fair/Poor Health Have disability, handicap,or chronic disease that
limits activity
Have chronic conditionthat requires ongoing
treatment
Wh�lemostadultwomen�ntheu .s .reportthe�rhealthstatusasexcellent,verygood,orgood,almostone-fifth(�8%)ofwomenreportthe�roverallhealthstatusasjustfa�rorpoor .th�sproport�on�ncreasesw�thage,r�s�ngfrom�0%amongwomen�8to29andreach�ng29%ofwomenage50to64 .ratesofd�sab�l�tyandchron�ccond�t�onsalsor�seaswomengetolder .overall,�4%ofwomenhavead�sab�l�tyorcond�t�onthatl�m�tsthe�rda�lyact�v�t�es,buttheratequadruplesfrom6%to24%betweenwomen�nthe�rearlyreproduct�veyearsandwomen�nthe�rlaterm�d-l�feyears,respect�vely .s�m�larly,thepresenceofchron�ccond�t�onsthatrequ�reongo�ngmed�calcaresuchasd�abetesorarthr�t�s,�ncreasesfrom�7%amongyoungwomen(�8to29)tooverhalf(52%)ofwomenage50to64 .
exHIBIt 1b
Health status Indicators, by age group
source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
39%
52%
24%
17%18%
29%
24%
18 to 29 30 to 39
10%6%
10%7%
14%
40 to 49 50 to 64
Fair/Poor Health Have disability, handicap,or chronic disease that
limits activity
Have chronic conditionthat requires ongoing
treatment
Percentage of women ages 18 to 64 reporting:
KeyFindingsFromtheKaiserWomen’shealthsurvey 7
ChaPter�:ProfileofWomen’shealth
raceandethn�c�tyhavelongbeenassoc�atedw�thd�fferences�nhealthstatus,w�thwomenofcolortyp�callyexper�enc�ngagreaterrateofhealthproblems .thesed�fferencesbecomemorenotableaswomenreachm�ddleage .amongwomenages45to64,afr�canamer�canwomenaremorel�kelytoreportfa�r/poorhealthstatus,hav�ngal�m�t�ngd�sab�l�ty,andhav�ngachron�cd�seasethanwomenwhoarewh�teorlat�na .
exHIBIt 1c
Health status Indicators, by race/ethnicity
note:amongwomenages45to64 .source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
56%
48%
38% 38%
27%
41%
25%
19% 20%
African American WhiteLatina
Fair/Poor Health Have disability, handicap,or chronic disease that
limits activity
Have chronic conditionthat requires ongoing
treatment
Percentage of women ages 45 to 64 reporting:
Womenareatr�skforaw�derangeofchron�ccond�t�ons .overall,themostfrequentlyreported�nwomen�ncludearthr�t�s(22%),hypertens�on(22%),andh�ghcholesterol(20%) .othercond�t�onssuchasobes�ty,asthma,andd�abetesarelessprevalent,buthavega�nedmoreattent�on�nrecentyearsbecauseofthe�rgrow�ngratesandthetolltheytake,part�cularlyoncerta�npopulat�ons .
ingeneral,theprevalenceofmostchron�ccond�t�ons�ncreasesw�thageamongwomen,oftendoubl�ngortr�pl�ngbetweenthereproduct�veandm�d-l�feyears .low-�ncomewomenhaveh�gherratesofasthma,obes�ty,andheartd�seasethanh�gher-�ncomewomen,butwomenw�thlower�ncomesreportlowerratesofthyro�dcond�t�onsthanh�gher-�ncomewomen .th�stocouldbeanart�factoftest�ngrelatedtopooreraccesstocareforth�spopulat�on .
Wh�leafr�canamer�canwomenreporth�gherratesofalmostallchron�ccond�t�onsthanlat�naandwh�tewomen,thestarkestd�fferencesarereportedforarthr�t�s,hypertens�on,andd�abetes,w�thrates� .5to2t�mesash�ghamongafr�canamer�cans .
exHIBIt 1d
Chronic Health Conditions, by selected Characteristics
note:amongwomenages�8to64 .*s�gn�f�cantlyd�fferentfromreferencegroup(�8to44,200%ofpovertyorh�gher,Wh�te),p< .05
source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
Condition (diagnosed by physician in past 5 years)
all WoMen
by age group poverTy level raCe/eTHnICITy
18–44 45–64
less than 200% of poverty
200% of poverty
or higherafrican
american latina White
Arthritis 22% 9% 39%* 24% 20% 54%* 36% 37%
Asthma/other respiratory 15% 14% 17% 20%* 13% 24% 16% 17%
diabetes 9% 5% 14%* 11% 8% 23%* 19% 11%
Heart disease 5% 2% 9%* 7%* 4% 10% 8% 9%
High cholesterol 20% 9% 34%* 20% 20% 32% 29% 34%
Hypertension 22% 11% 36%* 25% 21% 53%* 32% 33%
obesity 16% 12% 21%* 20%* 15% 29% 18% 21%
thyroid 11% 8% 16%* 8%* 13% 11% 13% 17%
8 Women’shealthCareChartbooK
ChaPter�:ProfileofWomen’shealth
depress�onandanx�etyarementalhealthcond�t�onsthataffectapprox�matelyaquarter(26%)ofallwomenages�8to64 .theprevalence�ncreasesw�thage,r�s�ngfrom23%ofwomenofreproduct�veageto29%ofm�d-l�fewomen .Wh�teandlat�nawomenreporth�gherratesofd�agnosedanx�etyanddepress�onthanafr�canamer�canwomen .approx�matelyone-th�rd(34%)oflow-�ncomewomenhavebeend�agnosedw�thanx�etyordepress�on�nthepastfiveyears,comparedto23%ofwomenw�thh�gher�ncomes .
exHIBIt 1e
Depression and anxiety, by selected Characteristics
note:200%ofthefederalpovertythresholdwas$35,200forafam�lyofthree�n2008 .*s�gn�f�cantlyd�fferentfromreferencegroup(45to64,Wh�te,200%ofpovertyorh�gher),p< .05 .
source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
Percentage of women ages 18 to 64 reporting they have been diagnosed with depression or anxiety in past �ve years by physician:
28%
23%
29%
34%*
16%*RACE/ETHNICITY
African American
White
Latina
Less than 200% of poverty
200% of poverty or higher
18 to 44
45 to 64
AGE GROUP All Women 26%
POVERTY LEVEL
25%
23%*
Womenexper�encestressfrommanyd�fferentsources,�nclud�ngthosegenerat�ngfromeconom�candhealthcareproblems .overone�n�0womenreportthatthe�rownhealthneeds(�3%)andthoseofafam�lymember(�6%)causethemalotofstress .aboutone�nfourwomenreportfeel�ngalotofstressfromthe�rjob/career(23%)andeconom�cconcerns(26%) .
Womenwhoarepoorerhealtharemorel�kelytoreportexper�enc�ngh�ghlevelsofstressresult�ngfromhealth,work,andfinanc�alconcernsthanwomenw�thbetterhealth .Forexample,fourt�mesasmanywomen�nfa�rorpoorhealth(34%)reportthatmanag�ngthe�rownhealthneedscausesthemalotofstresscomparedtowomen�nexcellenttogoodhealth(8%) .nearlyhalf(47%)ofwomenreport�ngfa�rorpoorhealthsaythatfinancescausealotofstress,asdo2�%ofwomen�nexcellenttogoodhealth .
exHIBIt 1f
sources of stress, by Health status
*s�gn�f�cantlyd�fferentfromexcellenttogood,p< .05 .^amongwomenwhoaremarr�ed,l�v�ngw�thapartner,orhaveach�ldunder�8�nthehousehold .^^amongwomenwhoareemployed .responsescale:alot,some,notmuch,nostressatall .source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
13%16%
23%26%
8%
13%
21% 21%
34%*
27%*
39%*
47%*
All women Fair/poor healthExcellent to good health
Managingown health
needs
Job/Career^^Health problemsa�ecting spouse,
partner, or children^
Financial concerns
Percentage of women ages 18 to 64 reporting they feel a lot of stress from:
CHAPTER 2:
Health Coverage
�0 Women’shealthCareChartbooK
ChaPter2:healthCoverage
morethan80%ofwomenbetweentheagesof�8and64havesomeformofhealth�nsurance .themajor�ty(6�%)arecoveredthroughemployer-sponsoredhealth�nsurance .asmallshareofwomen(6%)purchasethe�rownpr�vate�nsurancethrough�nd�v�dualpol�c�es .thepubl�csectorcoversmanywomen:med�ca�d,thepubl�cprogramforthepoor,ass�sts�0%,med�carecovers4%ofwomenunder65w�thd�sab�l�t�es,andasmallshareofwomen(2%)�scoveredunderothergovernmenthealthcare,suchasm�l�tary-sponsored�nsurancethroughChamPusandtriCare .desp�tethearrayofpr�vateandpubl�chealthcoverageopt�onsava�lable,�7%ofwomenages�8to64donothavehealth�nsurance .
Cover�ngtheun�nsured�sacentralelementofthenewhealthreformlawandalmostall�nd�v�dualsw�llberequ�redtohavecoverageby20�4 .med�ca�del�g�b�l�tyw�llbeexpandedtoass�stverylow-�ncomewomen,newpr�vate�nsurancemarketexchangesandsubs�d�esw�llbeava�labletoass�stthosew�thmodestormoderate�ncomes .inadd�t�on,anumberof�nsurancereformsw�llbe�mplementedthatw�llproh�b�t�nsurersfromturn�ngdownappl�cantsbasedonhealthstatus .thesechangesw�llaltertheprofileofwomen’shealthcoverage�nyearstocome .
exHIBIt 2a
Women’s Health Insurance Coverage
note:amongwomenages�8to64 .*other�ncludesChamPus,triCare,andunknown�nsurance .source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
Other*2% Individually
purchased6%
Employer-sponsored,dependent
29%Employer-
sponsored,primary
32%
Uninsured17%
Medicaid10%
Medicare4%
KeyFindingsFromtheKaiserWomen’shealthsurvey ��
ChaPter2:healthCoverage
theprofilesofwomencoveredbyd�fferenttypesof�nsurancereflectthed�fferentavenuesthat�nd�v�dualsobta�ncoverage�ntheu .s .notsurpr�s�ngly,ah�ghershareofwomenw�themployer-sponsored�nsurancehaveh�ghereducat�onlevelsandworkfull-t�me,comparedtowomenw�thotherformsofcoverage .
onaverage,womenwhopurchase�nd�v�dual�nsurancepol�c�esares�m�lartowomenw�themployer-sponsored�nsurance�nthattheyhaveh�gher�ncomeandeducat�onlevelsthanwomenw�thpubl�ccoverageorthosew�thout�nsurance .nearlyhalf(48%)ofwomenwhopurchase�nd�v�dual�nsurancealsoworkfull-t�me,yetforavar�etyofreasons,theymustpurchasethe�rown�nsurance,oftenbecausetheyarenotoffered�nsurancebythe�remployerorthe�rspouses,part�cularly�ftheyworkforasmallbus�ness .becausewomen�npoorhealthoftendonotqual�fyforcoverage�nthe�nd�v�dual�nsurancemarket,thosewhodopurchase�nd�v�dualpol�c�esarenotablymorel�kelytobe�nbetterhealth,eventhanthosewhoget�nsurancethroughthe�remployers .
becauseofthewaythatmed�ca�dprogramel�g�b�l�ty�sdes�gned,womenonmed�ca�darethepoorestgroup .however,th�sgroupofwomenarealsomostl�kelytobe�npoorerhealth,w�th30%report�nghealthstatusasfa�rorpoor,twotothreet�mestherateofthosew�themployeror�nd�v�dual�nsurance .
Wh�leemployment�samajorgatewaytohealth�nsurance,�t�snotaguaranteedentrance .approx�mately40%ofun�nsuredwomenworke�therfull-t�meorpart-t�meandmanymorel�kelyhavepartnerswhoareemployedouts�dethehome,yettheyst�lldonothaveaccesstocoveragebecausetheycannotafford�torbecausetheymaynotqual�fybecauseofhealthproblems .
exHIBIt 2b
Characteristics of Women, by Type of Insurance
employer-sponsored
Individually purchased Medicaid uninsured
Age
18 to 24 years 9% 19% 21% 23%
25 to 34 years 20% 9% 30% 24%
35 to 44 years 25% 27% 20% 21%
45 to 54 years 25% 19% 21% 21%
55 to 64 years 18% 26% 9% 10%
educAtIon
less than high school 3% 2% 33% 29%
High school 27% 31% 36% 35%
Post-high school 30% 32% 23% 27%
college graduate and higher 39% 35% 6% 8%
emPloYment
Full-time 60% 48% 13% 25%
Part-time 14% 18% 16% 15%
Retired 6% 11% 6% 3%
not employed 17% 18% 55% 51%
other* 6% 5% 9% 6%
HeAltH stAtus
excellent/very good/good 86% 92% 69% 75%
Fair/poor 13% 8% 30% 21%
notes:amongwomenages�8to64 .Columntotalsmaynotaddto�00%duetoround�ng .*other�ncludesstudent,don’tknow,refused .source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
�2 Women’shealthCareChartbooK
ChaPter2:healthCoverage
evenamongwomenwhohave�nsurance,coverage�snotalwaysstable .inadd�t�ontothe�7%ofwomencurrentlyun�nsured,7%ofwomenwhowere�nsuredatthet�methesurveywasconductedwereun�nsuredatsomepo�ntdur�ngthepr�oryear .onequarter(24%)ofwomenages�8to64arecurrentlyw�thouthealth�nsuranceorhavebeenun�nsuredatsomepo�nt�nthepastyear .
thoughmanyofthesewomengow�thouthealth�nsuranceforayearorless,morethanhalf(53%)werew�thouthealth�nsuranceforlongerthanayear;and27%ofwomenhadlong-termcoveragegapsofmorethanfouryears .gaps�ncoverageforlongerper�odsoft�mecanplacewomenatr�skfordelays�ntreatmentandlackofprevent�vecareandult�matelyaffecthealthoutcomes .
exHIBIt 2c
Duration of lack of Health Insurance Coverage
note:amongwomenages�8to64 .source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
Currently insured,but uninsured for a period in past year
Don’t know/Refused5%More than
4 years27%
More than 1 to 4 years
26%
1 year or less43%
Women’s insurance coveragestatus during past year:
Length of time withoutinsurance coverage:
Currentlyuninsured
17%
Insured full year76%
7%
theshareofwomenwhohavebeenun�nsuredforlongerper�odsoft�meshasbeenr�s�ng .by2008,27%ofun�nsuredwomenhadbeenw�thoutcoverageforatleastfouryears .th�s�san�ncreasefrom20%�n2004 .th�scouldreflectchanges�nemploymentratesandthegeneraldownturn�ntheeconomythatoccurredoverth�st�me .
exHIBIt 2d
growth in long-Term uninsured
*s�gn�f�cantlyd�fferentfrom2004,p< .05 .source:henryJ .Ka�serFam�lyFoundat�on,2001, 2004, 2008 Kaiser Women’s Health Surveys .
2001
20%
27%*
22%
2004 2008
Percentage of uninsured women ages 18 to 64 reporting they were uninsured for at least four years:
KeyFindingsFromtheKaiserWomen’shealthsurvey �3
ChaPter2:healthCoverage
Womenwhoareyoung,work�ngpart-t�me,orunemployedareath�ghestr�skforbe�ngun�nsured .th�s�slargelyduetothe�rlower�ncomesandlackofaccesstoemployment-basedcoverage .Full-t�meemployment,however,�snoguaranteeofcoverage,asnearlyone�ntenwomen(9%)whoworkfull-t�mewereun�nsured .
accesstoandaffordab�l�tyofcoveragearealsoproblemsforas�zableshareofwomen�npoorhealth,w�thone�nfive(20%)report�ngthattheywereun�nsured .thesewomenwered�sproport�onatelylow-�ncomeandmayhaved�fficultywork�ngduetothe�rhealthproblems;theyalsomaynotbeabletoaffordorqual�fyfor�nd�v�dual�nsurancebecauseofpre-ex�st�ngcond�t�ons .
exHIBIt 2e
uninsured rate by selected Characteristics
note:amongwomenages�8to64 .*s�gn�f�cantlyd�fferentfromreferencegroups(excellenttogood,full-t�meemployment,�8to29years),p< .05 .
source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
Excellent/very good/good
Fair/poor
Full-time
Part-time
Retired
Not employed
18 to 29 years
30 to 39 years
40 to 49 years
50 to 64 years
AGE
HEALTH STATUS
EMPLOYMENT STATUS
All Women 17%
15%
20%
9%
16%*
6%
32%*
26%
18%
12%*
12%*
Womenw�ththelowest�ncomes,whohadtheleastamountofmoneytospendonhealthcareweremostl�kelytobeun�nsured .Wh�leonly4%ofh�gher-�ncomewomen(fam�ly�ncomesof300%ormoreofpoverty)areun�nsured,35%ofwomenunderthepovertyl�neand29%ofnear-poorwomen(�00to�99%ofpoverty)werew�thoutcoverage .Poorwomenareun�nsuredatnearlyn�net�mestherateofwomen�ntheh�ghest�ncomelevel .
th�sd�spar�ty�sdue�nparttod�fferences�naccesstoemployer-basedhealthcoverage:h�gher-�ncomewomenare6 .5t�mesasl�kelyaspoorwomentohaveemployer-sponsoredhealth�nsurance(85%vs .�3%) .nearlythree-fourths(73%)ofpoorwomenandhalfofnearpoorwomenaree�therun�nsuredoronmed�ca�d .theava�lab�l�tyofmed�ca�d,wh�chcovers38%ofpoorwomenand�6%ofnear-poorwomen,g�vesmanymorewomenw�thl�m�tedresourcesaccesstocoverage .
exHIBIt 2f
Health Insurance Coverage, by poverty level
notes:amongwomenages�8to64 .�00%ofthefederalpovertythresholdwas$�7,600forafam�lyofthree�n2008 .*other�ncludesmed�care,ChamPus,triCare,andunknown�nsurance .source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
35% 29%
8% 4%
13%
41%73% 85%
4%
4%
7%3%
38%
16%
7% 1%1%
10% 10% 7%
Poor(less than 100%
of poverty)
Near-Poor(100% to 199%
of poverty)
Modest(200% to 299%
of poverty)
Higher Income (300% or more
of poverty)
Other*MedicaidIndividuallypurchased
Employer-sponsoredUninsured
�4 Women’shealthCareChartbooK
ChaPter2:healthCoverage
becausewomenofcoloraremorel�kelytowork�nlow-wagejobsandhaved�sproport�onatelylower�ncomes,theyarealsolessl�kelytowork�nplacesthatofferhealth�nsurancetothe�rworkersandmorel�kelytoqual�fyformed�ca�dbasedonlow�ncome .evenwhenemployersoffercoveragetolow-wageworkers,�t�smored�fficultforlow-wageworkerstoaffordthecostofprem�umsandsomeareforcedtooptout .
lackof�nsurance�saproblemforwomenofallracesandethn�c�t�esbutastagger�ng42%ofnon-elderlylat�nawomenareun�nsured,arate2 .5t�mesh�gherthanafr�canamer�canwomenand3 .5t�meswh�tewomen—andtheh�ghestrateofun�nsuranceofallgroupsofwomenexam�ned�nth�ssurvey .Just40%oflat�nawomenhaveemployer-sponsoredhealth�nsurance,ascomparedto67%ofwh�tewomen .l�kelat�nas,afr�canamer�canwomenhavelowerratesofemployer-sponsoredhealth�nsurance(49%)buthaveh�gherratesofmed�ca�dcoverage(23%)thanwh�tewomen .
exHIBIt 2g
Health Insurance Coverage, by race/ethnicity
note:amongwomenages�8to64 .*other�ncludesmed�care,ChamPus,triCareandunknowncoverage .source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
16%
42%
12%
49%
40%
67%
4%
4% 7%23%
11% 7%8% 3% 6%
African American Latina White
Other*Medicaid
Individually purchased
Employer-sponsored
Uninsured
CHAPTER 3:
Delivery System
�6 Women’shealthCareChartbooK
ChaPter3:del�verysystem
hav�ngaregularhealthcareprov�derhelpswomenma�nta�nacons�stentrelat�onsh�pw�ththehealthcaresystem,fostersthe�ruseofprevent�veserv�ces,andpromotesthe�raccesstocare .Wh�lemostwomen(83%)havearegularprov�der,s�gn�ficantd�spar�t�esex�stw�th�ngroupsofwomenbyage,race/ethn�c�ty,povertylevel,and�nsurancestatus .
aswomengetolder,theyaremorel�kelytohavearegularprov�der .n�ne�ntenwomenages45to64reporttheyseeaprov�deronaregularbas�s,comparedto77%ofwomenages�8to44 .onlytwo-th�rds(67%)oflat�nashavearegularprov�der,acons�derablylowerratethanafr�canamer�can(84%)andwh�tewomen(86%) .s�m�larly,low-�ncomewomen(7�%)aremuchlessl�kelytohavearegularprov�derthanh�gher�ncomewomen(90%) .
insurancestatus�salsoassoc�atedw�thwhetherornotwomenhavearegularprov�der .Fewerthanhalfofun�nsuredwomen(47%)haveaprov�dertheyseeonaregularbas�s,comparedtoapprox�matelyn�ne�ntenwomenw�thpr�vate�nsurance(9�%),med�care(90%)ormed�ca�d(87%) .
exHIBIt 3a
Women With a regular Health Care provider, by selected Characteristics
notes:amongwomenages�8to64 .200%ofthefederalpovertythresholdwas$35,200forafam�lyofthree�n2008 .*s�gn�f�cantlyd�fferentfromreferencegroups(45to64,Wh�te,200%ofpovertyandh�gher,Pr�vate),p< .05 .
source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
47%*
90%
86%
87%
90%*
67%*
90%
91%
71%*
84%
Uninsured
Medicaid
PrivateINSURANCE STATUS
Latina
African American
White
RACE/ETHNICITY
Less than 200% of poverty
200% of poverty and higher
POVERTY LEVEL
Medicare
All Women83%
45 to 64
AGE GROUP 18 to 44 77%*
amongwomenwhohaveregularprov�ders,many(44%)alsoseemorethanoneprov�dertocareforthe�rvar�etyofhealthneeds .hav�ngmult�pleprov�dersmayhelpmanywomenmanagethe�rw�derangeofhealthcareneeds,but�talsora�sesthe�mportanceofcont�nu�tyandcoord�nat�onofcarebetweenprov�ders .Conversely,�7%ofwomendonothaveanongo�ngrelat�onsh�pw�haprov�der .
exHIBIt 3b
number of providers Women see
source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008
Two or more providers
44%One regular
provider39%
No regular provider
17%
Percentage of women ages 18 to 64 reporting they see:
KeyFindingsFromtheKaiserWomen’shealthsurvey �7
ChaPter3:del�verysystem
mostwomenwhohavearegularprov�derseean�ntern�storfam�lypract�cephys�c�an(73%),w�ththeshare�ncreas�ngsl�ghtlyaswomenage .tenpercentofwomenstatethatanob-gyn�sthe�rregularprov�der,morecommonamongwomen�nthe�rreproduct�veyears(�4%)comparedtojust5%ofwomen�nm�ddleage .overall,8%ofwomenw�tharegularprov�derreportthatprov�der�saphys�c�anass�stantornursepract�t�oner .
thetypeofprov�derchangessl�ghtlyoverthecourseofwomen’sl�ves .dur�ngreproduct�veyears,acommoncomb�nat�on�sapr�marycareprov�derandanob-gyn .aswomenage,theyaremorel�kelytohaveatleasttwoprov�ders,butarealsolessl�kelytoseeanob-gynregularly .
exHIBIt 3c
provider specialties, by age group
among women who have a regular provider:
source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
thevastmajor�ty(86%)ofwomenhavehadatleastonev�s�tw�thahealthcareprov�der�nthepastyear .therewerenotlarged�fferencesbetweenwomenofd�fferentagegroupsorrace/ethn�c�t�es,butlat�nawomen,whooverallareayoungerpopulat�onandmorel�kelytobeun�nsured,weres�gn�ficantlylessl�kelytohaveseenaprov�der�nthepastyear .low-�ncomewomenwerealsolessl�kelytohaveseenaprov�der .thestarkestd�spar�tywasforun�nsuredwomen(67%),whoweremuchlessl�kelytohaveseenaprov�der,comparedtowomenw�thanyformof�nsurance .
exHIBIt 3d
provider visit in past year
note:200%ofthefederalpovertythresholdwas$35,200forafam�lyofthree�n2008 .*s�gn�f�cantlyd�fferentfromreferencegroup(Wh�te,200%ofpovertyorh�gher,Pr�vate),p< .05 .source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
provider Type all Women Women 18 to 44 Women 45 to 64
sPecIAltY oF RegulAR PRoVIdeR
Fam�lyPract�ceorinternalmed�c�ne 73% 70% 77%
ob-gyn �0% �4% 5%
otherspec�alty 3% 2% 4%
Phys�c�anass�stantornursePract�t�oner 8% �0% 9%
don’tKnow 4% 4% 4%
twoormoreProv�ders 53% 50% 56%
96%
89%
90%
91%
87%
88%
Uninsured
Medicare
Medicaid
Private
200% of poverty or higher
Less than 200% of poverty
White
Latina
African AmericanRACE/ETHNICITY
POVERTY LEVEL
INSURANCE STATUS
All Women 86%
67%*
Percentage of women ages 18 to 64 reporting they have seen a health care provider in the past year:
80%*
80%*
�8 Women’shealthCareChartbooK
ChaPter3:del�verysystem
two-th�rdsofwomenhadav�s�ttoanob-gyn�nthepastyear .notsurpr�s�ngly,women�nthe�rreproduct�veyears(69%)weremorel�kelytohavev�s�tedanob-gyn�nthepastyearthanolderwomen .asmallershareoflow-�ncomewomensawanob-gyn,asd�dwomen�npoorerhealth,comparedtowomen�nbetterhealthstatus .
exHIBIt 3e
use of gynecological Care, by selected Characteristics
*s�gn�f�cantlyd�fferentfromreferencegroup(45to64,Wh�te,200%ofpovertyorh�gher,excellenttogood),p< .05 .200%ofthefederalpovertythresholdwas$35,200forafam�lyofthree�n2008 .
source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
Percentage of women ages 18 to 64 with an Ob-Gyn visit in the past year:
AGE GROUP
RACE/ETHNICITY
POVERTY LEVEL
HEALTH STATUS
55%*
70%
65%
68%
67%73%
69%*18 to 44
45 to 64
African American
Latina
White
Less than 200% of poverty
200% of poverty or higher
Excellent to goodFair/poor
All Women 66%
59%
61%
spec�al�stsprov�dearangeof�mportantserv�cesforwomenw�thchron�c�llnessesormoreadvancedacutecond�t�ons .howeveraccesstospec�altycarecanbeaproblemforas�gn�ficantm�nor�tyofwomen .one�nfivewomenreportedthattheycouldnotseeaspec�al�st�nthepastyearwhentheythought�twasneeded .Womenw�thpr�vate�nsurancefaredbetterthanwomenw�thpubl�ccoverage,butst�ll�2%hadproblemsaccess�ngspec�altycare .morethanfour�ntenun�nsuredwomen(43%)andwomen�npoorerhealth(42%)reportedtheycouldnotseeaspec�altyprov�derwhenneeded .
exHIBIt 3f
access to specialists, by selected Characteristics
*s�gn�f�cantlyd�fferentfromreferencegroup(Pr�vate,excellenttogood),p< .05 .source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
43%*
31%*
42%*
30%*
15%
12%
Percentage of women ages 18 to 64 reporting that in the past year they were not able to see a specialist when they thought one was needed:
INSURANCE STATUS
HEALTH STATUS
Private
Uninsured
Excellent to good
Fair/poor
Medicaid
Medicare
All Women21%
KeyFindingsFromtheKaiserWomen’shealthsurvey �9
ChaPter3:del�verysystem
overt�me,accesstospec�al�stshasworsenedforwomen,w�thone-fifth(2�%)ofwomenreport�ngtheycouldnotseeaspec�al�stby2008,comparedto�6%justfouryearsearl�er .althoughth�ssurvey�snotabletoanalyzethereasonforth�sr�se�naccessproblems,th�scouldbeattr�butableto�ncreasedcosts,greaternumberofwomenw�thoutcoverage,and�ncreas�ngenrollment�nmanagedcareplansw�thmorerestr�ct�vegatekeeperarrangements .
exHIBIt 3g
Worsening access to specialty Care
*s�gn�f�cantlyd�fferentfrom200�and2004,p< .05 .source:henryJ .Ka�serFam�lyFoundat�on,2001, 2004, 2008Kaiser Women’s Health Surveys .
15%16%
21%*
2001 2004 2008
Percentage of women ages 18 to 64 reporting that in the past year they were not able to see a specialist when thought one was needed:
mentalhealthcareserv�cescanbeacr�t�calelementofcareformanywomen,aswomenareatgreaterr�skforexper�enc�ngcond�t�onssuchasanx�etyanddepress�onthanmen .overall,25%ofwomenreportedthattheyhadbeend�agnosedw�thanx�etyordepress�on(exh�b�t�e),and�2%ofwomenreportedsee�ngamentalhealthprofess�onal�nthepastyear .therateamongwomenreport�ngpoorerhealthstatus(2�%)wasdoublethatforwomenreport�ngbetterhealthstatus(�0%) .
exHIBIt 3h
use of Mental Health Care, by selected Characteristics
notes:includesv�s�tstopsych�atr�st,therap�st,counselor,andothermentalhealthprov�ders .200%ofthefederalpovertythresholdwas$35,200forafam�lyofthree�n2008 .*s�gn�f�cantlyd�fferentfromreferencegroup(45to64,200%ofpovertyorh�gher,excellenttogood),p< .05 .
source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008
AGE GROUP
POVERTY LEVEL
HEALTH STATUS
21%*
12%
13%
14%
18 to 44
45 to 64
Less than 200% of poverty
200% of poverty or higher
Excellent to good
Fair/poor
Percentage of women ages 18 to 64 who had a visit with a mental health professional in past year:
All Women12%
11%
10%
20 Women’shealthCareChartbooK
ChaPter3:del�verysystem
inrecentyears,therehasbeengrow�ngrecogn�t�onofthe�mportanceofqual�tyofhealthcare .overall,one�nfourwomen(26%)expressedconcernsaboutthequal�tyofhealthcaretheyrece�ved�nthepastyear .
low-�ncomewomen(32%)�npart�cularweremorel�kelytoexpressconcernsabouthealthcarequal�tythanwomenw�thh�gher�ncomes(23%) .therearealsod�fferencesby�nsurancestatus,w�thun�nsuredwomen(39%)andwomenwhohavemed�care(30%)ormed�ca�d(28%)allmorel�kelytoexpressconcernsaboutqual�tythanwomenw�thpr�vate�nsurance .Four�nten(42%)women�nfa�rorpoorhealthexpressedconcernsw�thqual�tycomparedto22%ofwomen�nbetterhealth .
exHIBIt 3i
Concerns about Quality of Care
note:200%ofthefederalpovertythresholdwas$35,200forafam�lyofthree�n2008 .*s�gn�f�cantlyd�fferentfromreferencegroup(Wh�te,200%ofpovertyandh�gher,Pr�vate,excellenttogood) .
source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
42%*
39%*
30%*
28%*
31%
21%
32%*
30%
INSURANCE STATUS
HEALTH STATUS
RACE/ETHNICITY
Uninsured
Medicaid
Private
Excellent to GoodFair/Poor
White
African American
Latina
Percentage of women ages 18 to 64 reporting they had concerns about the quality of health care they received in the past year:
Medicare
POVERTY LEVEL
200% of poverty and higher
Less than 200% of poverty
All Women26%
25%
23%
22%
overt�me,newsourcesofhealth�nformat�onhavedeveloped,namelythroughtechnologyandtheweb .however,womenarest�llmostl�kelytoturntoaprov�derwhenseek�ng�nformat�on,w�th44%report�ngprov�dersasthe�rlead�ngsource .thegrow�ngpresenceoftheinternet�sev�dencedthoughbythefactthatmorethanaquarterofwomen(28%)turnto�tfirstforhealth�nformat�on,mak�ng�tthesecondlead�ngprov�derof�nformat�on .�6%ofwomenfirstturntofam�lyandfr�endswhentheyaresearch�ngforhealth�nformat�on .
exHIBIt 3j
sources of Health Information
source:henryJ .Ka�serFam�lyFoundat�on,2008Kaiser Women’s Health Survey .
Percentage of women ages 18 to 64 who turn to particular source �rst when seeking health information:
Health care provider
44%
Internet28%
Family/friends16%
Books4%
Pharmacist3%
Other/none4%
KeyFindingsFromtheKaiserWomen’shealthsurvey 2�
ChaPter3:del�verysystem
therearenot�ceablegenerat�onald�fferences�nhowwomengethealth�nformat�on .Wh�lehealthcareprov�dersarethepr�marysourceforwomenofallages,theyarelessdom�nantamongyoungerwomen,whoalsorelyheav�lyonfam�lyandfr�endsandtheinternet .theinternetplaysthegreatestroleforwomen�nthe�rth�rt�esandfort�es,act�ngasthelead�ngsourceforalmostath�rdofwomen�ntheseagegroups .olderwomenarethemostl�kelytoseek�nformat�onfromaprov�der,yetevenamongwomen�nthe�rfift�esands�xt�es,almostaquarter(23%)turntotheinternetfirst .
exHIBIt 3k
sources of Health Information, by age group
source:henryJ .Ka�serFam�lyFoundat�on,2008Kaiser Women’s Health Survey .
38% 38% 42%53%
25%34%
32%23%
27%18% 13% 10%
10% 10% 12% 13%
18 to 29 years 30 to 39 years 40 to 49 years 50 to 64 years
Percentage of women ages 18 to 64 who turn to particular source�rst when seeking health information:
OtherFamily/friendsInternetHealth care provider
22 Women’shealthCareChartbooK
CHAPTER 4:
Prevention and Screening
24 Women’shealthCareChartbooK
ChaPter4:Prevent�onandscreen�ng
screen�ng�sanothercr�t�caltool�ntheprov�s�onofprevent�onserv�ces,early�dent�ficat�on,andmanagementofmanychron�c�llnesses .recommendat�onsforscreen�ngtestsarerev�ewedregularly,andoftenthereared�fferencesbetweenvar�ousprofess�onalgroupswh�chcanleadtoconfus�on .screen�ngrates�ncreasew�thage,asmorewomenfall�ntotherecommendedagegroupsandthe�nc�denceofcl�n�calhealthproblemsr�ses .
un�nsuredwomen�npart�culararelessl�kelytohaverece�vedanyscreen�ngtest,comparedtowomenw�themployer-sponsored�nsurance,notsurpr�s�ngg�ventheyhavelessaccesstoprov�dersandnocoverageforthecostsofthetests .Womenonmed�ca�dalsohaveloweruseofsomescreen�ngsthanwomenw�themployer-based�nsurance,butst�llhaveh�gherscreen�ngratesthanun�nsuredwomen .
exHIBIt 4a
screening Tests, by selected Characteristics
percentage of women ages 18 to 64 reporting they received a screening test in past two years:
n/anotappl�cable~samples�zetoosmallforrel�ableest�mate .*s�gn�f�cantlyd�fferentfromreferencegroup(45to64,Pr�vate),p< .05 .source:Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
age group InsuranCe sTaTus
screening Test all18 to
4445 to
64 private Medicaid Medicare uninsured
Physical/clinical breast exam 76% 73%* 81% 84% 65%* 87% 51%*
mammogram (ages 40 and older) 75% 67%* 77% 79% 67% 84% 50%*
Pap smear 78% 80%* 74% 82% 76% 72%* 65%*
colon cancer (ages 50 and older) 40% n/A 40% 42% ~ 51% 21%*
Blood pressure 91% 89%* 93% 96% 86%* 92% 74%*
Blood cholesterol 63% 52%* 77% 71% 47%* 78% 37%*
Counsel�ngandeducat�onarekeyelementsofprevent�on,management,andtreatmentofhealth�ssues .manywomenreportedtheyhadnotrecentlyhadaconversat�onw�thaprov�deraboutspec�fichealthr�sksandhealthbehav�orswh�charecons�deredtobe�mportanttowomen’shealth .themostfrequentlyd�scussed�ssuewasd�et,exerc�seandnutr�t�on,w�th67%ofwomensay�ngthatthe�rdoctoraskedaboutthesehealthhab�ts�nthepastthreeyears .
thenextmostfrequentlyd�scussedtop�cwasgett�ngenoughcalc�umtopreventboneloss(44%) .reflect�ngthe�ncreas�ngprevalenceofbonelossw�thage,womenages45-64(52%)weremorel�kelytod�scussth�stop�cw�ththe�rdoctorthanwomenages�8to44(36%),butst�llbelowrecommendedrates .d�scuss�onofothertop�cswaslessfrequent .aboutone-th�rdofwomenhadtalkedw�thaprov�deraboutsmok�ng(35%)andmentalhealth�ssues(35%)�nthepastthreeyears .aquarterhadrecentlyd�scussedalcoholordruguse(25%),w�tholderwomenlessl�kelytohaved�scussedth�sw�thaprov�derthanyoungerwomen(�9%and29%,respect�vely) .
exHIBIt 4b
Counseling about Health behaviors, by age group
source:Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
19%
32%
33%
52%
68%
29%
36%
37%
36%
65%
25%
35%
35%
44%
67%
Alcohol or drug use
Mental health issues
Smoking
Getting enough calciumto prevent bone loss
Diet, exercise, nutrition
Percentage of women ages 18 to 64 reporting they have discussed topic with doctor or nurse in past 3 years:
All Women
18 to 44
45 to 64
KeyFindingsFromtheKaiserWomen’shealthsurvey 25
ChaPter4:Prevent�onandscreen�ng
therehasbeengrow�ng�nterestandawarenessamongthepubl�caboutther�s�ngprevalence�nchron�c�llnesses,and�npart�culartheroleofprevent�on .between200�and2008,theshareofwomenwhoreportedthattheyhadbeend�agnosedw�thobes�ty�nthepr�orfiveyearsrosefrom��%to�6% .atthesamet�me,thereseemstobegrow�ngawarenessamongprov�dersaswell .between2004and2008,theshareofwomenwhohadtalkedw�thaprov�der�nthepr�oryearaboutd�et,exerc�se,andnutr�t�on�ssues�ncreasedfrom39%to49% .ratesofscreen�ngforh�ghcholesterolalso�ncreasedfrom56%�n200�to63%�n2008 .
exHIBIt 4c
growing attention to obesity and related Conditions
#Quest�onnotasked�n200� .*s�gn�f�cantlyd�fferentfrom2004,p< .05 .**s�gn�f�cantlyd�fferentfrom200�and2004,p< .05 .source:henryJ .Ka�serFam�lyFoundat�on,2001, 2004, 2008 Kaiser Women’s Health Surveys .
56%
39%
59%
49%*
63%**
Talked with provider about diet,exercise, nutrition in past year#
Had cholesterol in past 2 years
Percentage of women ages 18 to 64 reporting they:
2001 2004 2008
Counsel�ngonsexualhealthtop�cscanbeasens�t�vetop�cforbothpat�entsandhealthcareprov�ders .desp�tethe�mportanceofsexualhealthforwomenthroughoutthe�rl�fespan,counsel�ng�s�nfrequentevenamongwomen�nthe�rpeakreproduct�veyears .Justth�rty-e�ghtpercentofwomenages�8to44hadarecentconversat�onw�thaprov�deraboutthe�rsexualh�story .Wh�leprevent�onandtreatmentofsexuallytransm�ttedd�seases(stds)cont�nuestobeamajorpubl�chealthchallenge,fewerthanone�nthreewomen�nthe�rreproduct�veyearshadd�scussedstds(28%)orhiv/aids(29%)w�thahealthcareprov�der�nthepastthreeyears .d�scuss�onofdomest�cordat�ngv�olence(�5%)wasevenmorel�m�ted .
exHIBIt 4d
Counseling about sexual Health
source:Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
Percentage of women ages 18 to 44 reporting they have discussed topic with doctor or nurse in past 3 years:
Sexual history 38%
28%
29%
15%
Sexually transmitted diseases
HIV/AIDS
Domestic or dating violence
26 Women’shealthCareChartbooK
ChaPter4:Prevent�onandscreen�ng
manywomen�nthe�rreproduct�veyearsareatr�skforsexuallytransm�tted�nfect�ons,suchashPv,chlamyd�a,andhiv .test�ngforstdssuchasChlamyd�aandgonorrhea�s�mportantforearly�dent�ficat�onand�ntervent�on .yetonlyth�rtypercentofwomenages�8to49reportthattheyhavebeentestedforanstd�nthepasttwoyears .theactualfigure�sl�kelylower,howevers�nce35%ofthesewomenwereunderthe�mpress�onthatstdtest�ngwasarout�nepartofanexam,wh�chcannotbeassumed .
thestory�ss�m�larforhivtest�ng,butthereevengreateruncerta�nty .th�rty-s�xpercentofwomenreportedhav�nganhivtest�nthepasttwoyears,butmorethanhalf(53%)assumed�twasarout�nepartofanexam,wh�ch�softennotthecase .
exHIBIt 4e
HIv and sTD Testing
source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008
Under impression testwas routine part
of exam54%
Asked tobe tested
34%
Don’t know/Refused
3%
HIV TESTING
STD TESTING
Don’t know/Refused 2%
Have not had HIVtest in past two years
62%
Have not had STDtest in past two years
68%
Have had HIV test in past two years
36%
Have had STDtest in past two years
30%
Don’t know/Refused
1%
Percentage of women ages 18 to 49 who received test in past two years:
Doctor recommended10%
Under impression testwas routine part
of exam35%
Asked tobe tested
53%
Doctor recommended11%
KeyFindingsFromtheKaiserWomen’shealthsurvey 27
ChaPter4:Prevent�onandscreen�ng
inJune2006,theFdaapprovedanewvacc�neaga�nsthumanPap�llomav�rus(hPv)foruse�nwomenages9-26 .Follow�nganextens�vemed�acampa�gnbythemanufacturerandmanynewsstor�es,bysummer2008,mostwomenhadheardofthevacc�ne .advert�s�ngwasthelead�ngsourceof�nformat�on,w�ththemajor�tyofwomen(62%)report�ngthatasthemed�umforhear�ngaboutthevacc�ne .healthcareprov�derscont�nuetoplayan�mportantrole,w�th20%ofsay�ngtheylearnedaboutthevacc�nefromaprov�der .
exHIBIt 4f
sources of Information on Hpv vaccine
source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008
Of women ages 18 to 64 who have heard of vaccine, the percentage who heard through:
Advertisements62%
Health careprovider
20%
News story 7%
Family/friends6%
Other 5%
28 Women’shealthCareChartbooK
CHAPTER 5:
Access and Affordability
30 Women’shealthCareChartbooK
ChaPter5:accessandaffordab�l�ty
affordab�l�tyofcareamajorconcernformanyhealthcareconsumers .healthcarecosts,suchas�nsuranceprem�ums,co-payments,deduct�bles,andserv�cesthatarenotcovered,canqu�cklyescalateandl�m�taccesstocare .
oneoutoffourwomen(24%)reportthattheywentw�thoutcaretheythoughttheyneededbecausetheycouldnotafford�t .notsurpr�s�ngly,womenw�thlower�ncomeswhohavethehardestt�mepay�ngforhealthcare,aremuchmorel�kelythanthe�rh�gher-�ncomecounterpartstodelayorgow�thoutserv�ces .almosthalf(46%)ofpoorwomenandalmostone-th�rd(3�%)ofnear-poorwomensk�ppedordelayedneededcarebecauseofthecosts,comparedto��%oftheh�ghest�ncomegroup .
Womenw�thout�nsurancearealsoatmuchh�gherr�skforpostpon�ngorforego�ngcare,w�thmorethanhalf(55%)ofun�nsuredwomendo�ngso,comparedto3�%ofwomenonmed�ca�d,2�%ofwomenonmed�care,and�4%ofwomenw�thpr�vate�nsurance .however,thesedataalso�llustratethatevenwomenw�th�nsurancecanfaceaffordab�l�tybarr�ers .
exHIBIt 5a
Delayed or Went Without Care because of Cost, by poverty and Insurance status
*s�gn�f�cantlyd�fferentfromreferencegroup(300%ofpovertyandh�gher,Pr�vate),p< .05 .note:�00%ofthefederalpovertythresholdwas$�7,600forafam�lyofthree�n2008 .source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
All Women24%
46%*
14%
31%* 31%*
11%
55%*
Percentage of women ages 18 to 64 reporting they delayed or went without care they thought they needed in the past year because of the cost:
POVERTY LEVEL INSURANCE STATUS
Less than100%
poverty
100% to199% ofpoverty
200% to299% ofpoverty
300% ofpoverty
and higher
Private Medicaid Medicare Uninsured
22%* 21%
youngerwomen,whotyp�callyhavelowerearn�ngsaremorel�kelytodelaycarebecauseofcosts,asarewomenofcolor,andthose�ntheworsthealthstatus .thesearegroupswhohaveh�gherratesoflackof�nsuranceand�nmanycases,part�cularlythosewhofacepoorhealth,haveagreaterneedforhealthcareserv�ces .
exHIBIt 5b
Delayed or Went Without Care because of Cost, by selected Characteristics
*s�gn�f�cantlyd�fferentfromreferencegroup(45to64,Wh�te,excellenttogood),p< .05 .source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
26%
21%
26%
32%*
22%
20%
37%*
HEALTH STATUS
RACE/ETHNICITY
Excellent to Good
Fair/ Poor
African American
White
Latina
Percentage of women ages 18 to 64 reporting they delayed orwent without care they thought they needed in the past year because of the cost:
AGE GROUP
18 to 44
45 to 64
KeyFindingsFromtheKaiserWomen’shealthsurvey 3�
ChaPter5:accessandaffordab�l�ty
somewomendealw�thhealthcarecostpressuresbymak�ngtradeoffsw�thotherexpenses,andth�sseemstobegett�ngworse .between2004and2008,theshareofwomenreport�ngtheyhadtospendlessonotherbas�cneedstopayforhealthcaredoubledfrom8%to�6% .thedualpressuresof�ncreas�nghealthcarecostsandtherecess�onhavel�kelystra�nedmanywomenandaffectedthe�rab�l�tytomakeendsmeetandpayforcare .th�ssurveywasconducted�ntheearl�erdaysoftheeconom�ccasesandth�snumbermayhavebeenevenh�gherdur�ngthepeakofthecr�s�s .
exHIBIt 5c
More evidence of Tradeoffs to pay for Health Care
note:otherbas�cneeds�ncludefood,ut�l�t�es,andother�tems .*s�gn�f�cantlyd�fferentfrom2004,p< .05 .source:henryJ .Ka�serFam�lyFoundat�on,2004,2008Kaiser Women’s Health Surveys .
8%
16%*
2004 2008
Percentage of women ages 18 to 64 reporting they spent less on other basic needs in the past year to have enough money for health care:
notsurpr�s�nglypoorerandun�nsuredwomenaremorel�kelytomaketradeoffs�nordertopayforhealthcare .approx�matelyaquarterofwomenwhoareun�nsured(25%),onmed�ca�d(26%),low-�ncome(27%),afr�canamer�can(24%),orlat�na(24%)reportspend�nglessonotherbas�cneedstohaveenoughmoneytopayforhealthexpenses .therate�sevenh�gheramongwomen�ntheworsthealthstatus(30%),and�smorethantw�ceash�ghthanwomen�nbetterhealth(�3%) .
exHIBIt 5d
financial Tradeoffs to pay for Health Care
note:200%ofthefederalpovertythresholdwas$35,200forafam�lyofthree�n2008 .*s�gn�f�cantlyd�fferentfromreferencegroup(Pr�vate,200%ofpovertyandh�gher,Wh�te,excellenttogood),p< .05 .
source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
HEALTH STATUS
RACE/ETHNICITY
Excellent to Good
Fair/ Poor
African American
White
Latina
POVERTY LEVELLess than 200% of poverty
200% of poverty and higher
Percentage of women ages 18 to 64 reporting they spent less on other basic needs in the past year to have enough money for health care:
INSURANCEPrivate
Medicaid
Uninsured 25%*
14%
11%
26%*
13%
24%*
27%*
12%
30%*
24%*
32 Women’shealthCareChartbooK
ChaPter5:accessandaffordab�l�ty
Women’saccesstohealthcare�ntersectsw�thahostofotherhealth-related�ssues,aswellasfam�ly,work,andeconom�crespons�b�l�t�es .morethanone�ntenwomenstatedthattheydelayedorwentw�thoutneededcarebecausetheyd�dnothave�nsurance(�5%)orapersonalphys�c�an(�3%) .twenty-threepercentofwomenc�tedt�measafactor�ndelay�ngorprevent�ngrece�ptofcare,and�8%statedthattheycouldn’ttaket�meoffwork .Formothers,lackofch�ldcarealsoplaysarole,as�3%statedtheyd�dn’trece�vecarewhentheyneeded�tbecauseofproblemsfind�ngch�ldcare .almostone�nten(8%)statedtransportat�onwastheproblem�ngett�nghealthcare .
v�rtuallyacrosstheboard,low-�ncomewomenreportedh�gherratesofthesechallenges,oftentwotothreet�mesash�gh .theoneexcept�onwaslackoft�me,wh�chaffectedallwomenalmostequally .
exHIBIt 5e
reasons for Delaying or going Without Care, by poverty level
note:200%ofthefederalpovertythresholdwas$35,200forafam�lyofthree�n2008 .*s�gn�f�cantlyd�fferentfrom200%ofpovertyandh�gher,p< .05 .^amongwomenwhoareemployed .^^amongwomenw�thch�ldrenyoungerthan�8yearsl�v�ng�nhousehold .source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008
Percentage of women ages 18 to 64 reporting they delayed or went without care they thought was needed in the past 12 months due to:
15%
29%*
7%
13%
23%*
8%
23%21%
24%
18%
26%*
17%
13%
17%*
8% 8%
19%*
2%
All women 200% of poverty or higherLess than 200% of poverty
Noinsurance
Nodoctor
Couldn’tfind time
Couldn’t taketime o� work^
Child care problems^^
Transportationproblems
half(5�%)ofwomenrelyonaprescr�pt�onmed�c�neonanongo�ngbas�s .useofprescr�pt�ondrugs�sshapedbyhealthneeds,accesstocare,andaffordab�l�tyofmed�cat�ons .theproport�onofwomenwhorelyondrugsonaregularbas�s�ncreasesw�thage,astherateofchron�c�llnessesalso�ncreasesandtheneedformed�cat�onsr�ses .Wh�tewomen(56%)aremorel�kelythanwomenofcolortotakeaprescr�pt�onmed�c�neregularly,l�kelyduetothe�rh�gherratesof�nsuranceandrelat�velyh�gher�ncomesandbetteraccesstocare .notsurpr�s�ngly,therearealsosharpd�fferencesby�nsurancestatus .thevastmajor�ty(80%)ofyoungerwomenages�8to64onmed�care,takeaprescr�pt�onmed�c�neregularly,notsurpr�s�ngs�ncemosthavesevered�sab�l�t�es .abouthalfofwomenw�thpr�vate�nsurance(54%)ormed�ca�d(48%)useaprescr�pt�onmed�c�neregularly,amuchh�ghersharethanwomenwhoareun�nsured(3�%)andhavenocoverageatalltocoverthecostsofdrugsandmorel�m�tedaccesstocare .
exHIBIt 5f
use of prescription Drugs, by selected Characteristics
*s�gn�f�cantlyd�fferentfromreferencegroup(45to64,Wh�te,Pr�vate),p< .05 .source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008
AGE
RACE/ETHNICITY
INSURANCE STATUS
18 to 44
45 to 64
African American
Latina
White
Uninsured
Private
Medicaid
Medicare
Percentage of women ages 18 to 64 reporting they use at least one prescription drug on a regular basis:
All Women51%
63%
31%*
56%
80%*
34%*
48%
47%*
54%
42%*
KeyFindingsFromtheKaiserWomen’shealthsurvey 33
ChaPter5:accessandaffordab�l�ty
amongwomenwhouseprescr�pt�ondrugsonaregularbas�s,mostuseonlyoneortwoprescr�pt�onsregularly(54%),butas�zablem�nor�ty(�4%)dotakeatleasts�xd�fferentmed�cat�onsonaregularbas�s .notsurpr�s�ngly,therearemajord�fferencesbyageandhealthstatus .Womenwhoare45-64yearsold(23%)areabouts�xt�mesasl�kelyasyoungerwomentotakeatleasts�xmed�cat�onsonanongo�ngbas�s .thesame�struewhencompar�ngwomen�nthepooresthealth(35%)towomen�nthebesthealthstatus(6%) .
exHIBIt 5g
number of prescription Drugs, by age and Health status
source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008
54%70%
40%
63%
27%
32%
26%
37%
31%
36%
14%4%
23%6%
35%
ALL WOMEN
18 to 44 45 to 64 Excellent toGood Health
Fair/PoorHealth
Among women ages 18 to 64 who take at least one prescription medicine on a regular basis, the number of drugs they take:
AGE HEALTH STATUS
6 or more3 to 51 or 2
4%
drugcostsareas�zableconcernformanywomen .nearlyone-quarterofwomen(23%)reportedthattheyd�dnotfillaprescr�pt�onmed�c�neduetocosts,andalmostone�nfive(�8%)womensk�ppedortooksmallerdosesofmed�cat�onstomakethemlastlonger .ofthosewomenwhod�dnotfillaprescr�pt�onorsk�ppedortooksmallerdoses,55%reportedthattheyhadtoldadoctorofthesetradeoffs(datanotshown) .
notsurpr�s�ngly,alargershareofwomen�nfa�r/poorhealth(73%)thanwomen�nexcellenttogoodhealth(47%)takeaprescr�pt�onmed�cat�ononaregularbas�s(datanotshown) .however,women�npoorerhealtharealsoatleasttw�ceasl�kelytocomprom�semed�cat�onusebecauseofcost .th�rty-e�ghtpercentofwomen�npoorerhealthd�dnotfillaprescr�pt�onbecauseofthecosts,comparedto�9%ofwomen�nbetterhealth .s�m�larly,36%ofwomen�npoorerhealthsk�ppedortooksmallerdosestostretchoutmed�cat�ons,comparedto�4%ofwomen�nbetterhealth .th�s�sofpart�cularconcern,g�venthatm�ss�ngmed�cat�onsmayjeopard�zewomen’shealth,part�cularlythose�npoorerself-reportedhealthstatus .lower-�ncomewomenwerealsomorel�kelytosk�pprescr�pt�onsorcutdoses�nthefaceofcostchallenges .
exHIBIt 5h
prescription Drug Costs, by selected Characteristics
note:200%ofthefederalpovertythresholdwas$35,200forafam�lyofthree�n2008 .*s�gn�f�cantlyd�fferentfromreferencegroup(excellenttogood,200%ofpovertyandh�gher)p< .05 .
source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
HealTH sTaTus poverTy level
percentage of women ages 18 to 64 reporting that in the past year they:
all WoMen
excellent to good
fair or poor
less than 200%
of poverty
200% of poverty
and Higher
did not fill prescription medicine due to cost 23% 19% 38%* 35%* 18%
skipped or took smaller doses of prescription medicines to make them last longer 18% 14% 36%* 28%* 14%
34 Women’shealthCareChartbooK
ChaPter5:accessandaffordab�l�ty
although�nsurance�san�mportantfactor�naffordab�l�tyofprescr�pt�onmed�c�nes,�tdoesnotcompletelyel�m�natecostbarr�ers .e�ghteenpercentofwomenw�themployer-based�nsurancesa�dtheyd�dnotfillaprescr�pt�on,and�3%sk�ppedortooksmallerdosestomakemed�c�neslastlongerbecauseofcosts .however,costproblemsaffectedas�gn�ficantshareofwomenwhoareun�nsured,onmed�ca�d,ormed�care,whoared�sproport�onatelylow�ncomeandhavefewerresourcesevenform�n�malco-payments .
exHIBIt 5i
prescription Drug Costs, by Insurance status
*s�gn�f�cantlyd�fferentfromPr�vate,p< .05 .source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
18%
13%
30%*28%*
31%*29%*
34%*
27%*
INSURANCE STATUS:
Percentage of women ages 18 to 64 reporting that in the past year they:
Private Medicaid Medicare Uninsured
Did not �ll prescription medicinedue to costs
Skipped or took smaller doses ofprescription medicines to make
them last longer
CHAPTER 6:
Work, Family, and Caregiving
36 Women’shealthCareChartbooK
ChaPter6:Work,Fam�ly,andCareg�v�ng
nearlyhalf(46%)ofadultwomenhavech�ldrenunderage�8athome(datanotshown) .Womenw�thch�ldrenoftenfacechalleng�ngt�meconstra�ntsandmustbalancemult�pleobl�gat�ons .inthe�rrolesasmothers,womenarethepr�marycaretakersofthe�rch�ldren’sneeds,�nclud�ngmanag�ngthe�rhealthcare .aboutone�nfive(2�%)mothersares�ngleparentsands�x�nten(59%)workouts�dethehousee�therfull-t�meorpart-t�me .manymothersalsocontendw�ththe�rownhealthconcerns .inpart�cular,�8%areun�nsured .
exHIBIt 6a
Characteristics of Mothers and guardians of Dependent Children
note:mothers/guard�ansreferstowomenw�thch�ldrenunder�8�nthehousehold .source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
8% 12% 9%
Full-time45%
Part-time14%
Not Working40%
Married70%
Lives withPartner
Divorced/Separated/Widowed Never
Married
Private/Other68 %
Medicaid14%
Uninsured18%
MaritalStatus
EmploymentStatus
InsuranceStatus
Womenarethepr�marycoord�natorsofhealthcareforthe�rch�ldren .thevastmajor�tyofmothersselectthe�rch�ldren’sdoctor(85%),takethemtodoctor’sappo�ntments(84%),andensurethattheyobta�nrecommendedcare(79%) .asmallport�onofmothersreportthattheysharetheserespons�b�l�t�esw�ththe�rspousesandpartners .
exHIBIt 6b
Caring for Children’s Health
note:mothersarewomenw�thch�ldrenunder�8�nthehousehold .source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
Percentage of mothers/guardians who usually:
85%
11%2%
1%
Select child’sdoctor
84%
10%4%
1%
Take child to doctor’s appointment
79%
16%3%
1%
Ensure child obtainsrecommended care
Other Adult/Don’t Know/NASpouse/PartnerMother Joint Responsibility
KeyFindingsFromtheKaiserWomen’shealthsurvey 37
ChaPter6:Work,Fam�ly,andCareg�v�ng
asthepr�marycoord�natorsofhealthcareforthe�rch�ldren,manywork�ngwomen(48%)musttaket�meoffwhenthe�rch�ldrengets�ck .aboutone-fifthofwomenreportedthatthe�rspouses(�8%)orsomebodyelse(22%)couldtakecareofthe�rch�ldrenwhenneeded .however,ontopofshoulder�ngpr�maryrespons�b�l�tyforcar�ngfors�ckch�ldren,abouthalf(47%)ofwomenwhodon’thavech�ldcarealternat�veslosepaywhentheystayhometocareforas�ckch�ld .
exHIBIt 6c
Impact of family Health responsibilities
note:amongmothersofch�ldrenunder�8�nthehousehold,whoarework�ngfull-t�meorpart-t�me .source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
Paid leave bene�t: Working mothers’ options when child is sick:
Loses pay whenmissing work
47%
Receives paywhen missing
work53%
Miss work48%
Can call onsomeone else
22%
Child can stayhome alone
8%
Don’t know/refused4%
Spouse/partnercares for child
18%
nearlys�x�nten(59%)womenworkouts�dethehome,e�therfull-t�meorpart-t�me .Workrelatedfr�ngebenefitsl�kepa�ds�ckleaveandvacat�ont�meallowworkerstotaket�meoff�nthecaseofan�llness,toattendtofam�lymatters,takeavacat�on,andahostofotherreasons .d�sab�l�ty�nsurancecanoffer�mportantfinanc�alprotect�on�ntheeventofan�njurythatpreventsaworkerfrombe�ngabletowork .ret�rementplans,suchasa40�(k)helpworkersplanandsaveforexpenses�ntheret�rementyearswhentheymayl�veonfixed�ncomes .overs�x�ntenwomenwork�ngouts�dethehomereportthatthe�remployersofferthemthesebenefits .
desp�tethe�mportanceofthesebenefits�neconom�csecur�ty,acrosstheboard,work�nglow-�ncomewomenarelessl�kelytohaveaccesstoanyofthem .Fewerthanhalfoflow-�ncomewomenareofferedpa�ds�ckleave(45%),d�sab�l�ty�nsurance(42%),oraret�rementplan(44%),whereasapprox�matelyseven�ntenwomenw�thh�gher�ncomesworkforemployersoffer�ngthesebenefits .
exHIBIt 6d
Workplace benefits
note:amongwomenwhoareemployedfull-t�meorpart-t�me .*s�gn�f�cantlyd�fferentfrom200%ofpovertyorh�gher .note:200%ofthefederalpovertythresholdwas$35,200forafam�lyofthree�n2008 .source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
Percentage of working women ages 18 to 64 reporting their employer o�ers them:
62%
45%*
69%
All women 200% of poverty or higherLess than 200% of poverty
Paid sick leave
68%
59%*
72%
Paid vacation
60%
42%*
68%
Disability insurance
65%
44%*
74%
Retirement plan
38 Women’shealthCareChartbooK
ChaPter6:Work,Fam�ly,andCareg�v�ng
Womenwhoworkouts�dethehomeoftenjugglethe�rcareersw�thotherrespons�b�l�t�essuchasch�ldrear�ng,careg�v�ng,andcommun�tywork .thus,flex�b�l�ty�ntheworkday�san�mportantfactorforwork�ngwomen .abouthalfofwork�ngwomenreportthattheyhaveagreatdealofflex�b�l�ty�nwhentheytakebreaksorwhentheytakedaysofftocareforas�ckfam�lymember .Fewerwomen(32%)reportagreatdealofflex�b�l�ty�nthe�rstart�ngandqu�tt�ngt�mesandchang�ngthe�rhours .th�stypeofflex�b�l�ty�spart�cularly�mportant�ntermsofgett�ngmed�calcarewh�lecar�ngforhealthoffam�lymembers .
low-�ncomewomenreportlessflex�b�l�ty�nmostaspectsofthe�rworkdaycomparedtowomenw�thh�gher�ncomes .thestarkestd�spar�ty�s�ntak�ngbreaks .Justoverone-th�rd(35%)oflow-�ncomewomenhaveflex�b�l�ty�nbreakt�mes,comparedtojustoverhalf(52%)ofwomenw�th�ncomesat200%andh�gherofpoverty .
exHIBIt 6e
flexibility in Work Day
notes:amongthosewhoareemployedfull-t�meorpart-t�me .200%ofthefederalpovertythresholdwas$35,200forafam�lyofthree�n2008 .responsescale:agreatdeal,moderateamount,veryl�ttle,noneatall .*s�gn�f�cantlyd�fferentfrom200%ofpovertyorh�gher .source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
Percentage of working women ages 18 to 64 reporting they have a great deal of �exibility in their work day in:
47%
36%*
52%
32%27%
35%32%
28%
34%
49%
41%*
53%
When they takebreaks
Starting and quittingtimes
Changing theirhours
Taking days o� to carefor a sick family member
All women 200% of poverty or higherLess than 200% of poverty
inadd�t�ontothe�rregularfam�lyobl�gat�ons,�2%ofwomencareforafam�lymemberwho�schron�cally�llord�sabled .innearlytwo-th�rdsofcases(62%),thesewomenarethepr�marycareg�versforthese�nd�v�duals,andmanageaw�derangeofthe�rmed�cal,household,andda�lyneeds(datanotshown) .
Careg�versoftenjugglemult�plerespons�b�l�t�esandfaceeconom�candhealthchallengesofthe�rown .Four�n�0(4�%)careg�vershavech�ldrenunder�8andoverhalf(55%)areemployed .manycareg�versalsodealw�ththe�rownhealthchallenges,�9%areun�nsured,overhalf(5�%)haveachron�chealthcond�t�on,and28%descr�bethe�rownhealthasfa�rorpoor .
exHIBIt 6f
profile of family Caregivers
*Careg�versarewomenages�8to64whoarecar�ngforachron�cally�llord�sabledrelat�ve .source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
28%
51%
19%
55%
41%
73%
55%
Percentage of family caregivers* who are:
Ages 45 to 64
Married/living with partner
Child under 18 in household
Employed
Uninsured
Chronic health condition
Fair/poor health
KeyFindingsFromtheKaiserWomen’shealthsurvey 39
ChaPter6:Work,Fam�ly,andCareg�v�ng
manycareg�versdevoteas�gn�ficantamountoft�metocar�ngforthe�rs�ckord�sabledfam�lymember .approx�matelyone-fifth(�9%)of�nformalcareg�versspendtheequ�valentofafull-t�mejob-morethan40hours-car�ngforthe�rchron�cally�llrelat�ve .Fam�lycareg�versgenerallydonotrece�vepayforthe�rt�me,andforthosewhodo�tonafull-t�mebas�s,the�rab�l�tytoearn�ncomethroughouts�dework�scomprom�sed .infact,2�%ofcareg�versreportthatcareg�v�ngstra�nsthe�rhouseholdfinances .one-th�rd(32%)saythatthecareg�v�ng�tselfresults�nalotofstress .
exHIBIt 6g
Impact of Caregiver responsibilities
*Careg�versarewomenages�8to64whoarecar�ngforachron�cally�llord�sabledrelat�ve .source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
32%
21%
19%
Feel a lot of stress fromcaregiving responsibilities
Caregiving places strainon family �nances
Spend more than 40 hoursper week on caregiving
Percentage of family caregivers* reporting:
40 Women’shealthCareChartbooK
MeTHoDs
thedata�ntheKa�serWomen’shealthCareChartbookarebasedontelephone�nterv�ewsw�thanat�onallyrepresentat�vesampleof2,0�5womenaged�8to64l�v�ng�nthecont�nentalun�tedstates .interv�ewswerecompleted�nbothengl�shandspan�sh,accord�ngtothepreferenceoftherespondentandwereconductedfrommay2�throughJuly29,2008 .
theKa�serFam�lyFoundat�oncontractedw�thPr�ncetonsurveyresearchassoc�atesinternat�onal(Psrai)toconductthefieldworkforth�ssurvey .theselectedsample�sarandomd�g�tsampleoftelephonenumbersselectedfromtelephoneexchanges�nthecont�nentalun�tedstates .thetelephonesamplewasprov�dedbysurveysampl�nginternat�onal,llC(ssi)accord�ngtoPsraispec�ficat�ons .thesample�sbasedonad�sproport�onatelystrat�fiedrandom-d�g�tsampleoftelephonenumberssothatthefinal
sampleofcompleted�nterv�ewswouldconta�nad�sproport�onatelylargenumberofafr�can-amer�canandlat�narespondentsaswellasalargernumberofwomenmed�callyun�nsured,low-�ncomeorrece�v�ngmed�ca�d .thedataarewe�ghted�nanalys�storemovethed�sproport�onfromtheselect�onratesbystratumandtomakethedatafullyrepresentat�veofnon-elderlyadultwomen�nthecont�nentalun�tedstates .
atleast�0attemptsweremadetocompletean�nterv�ewateverysampledtelephonenumber .thecallswerestaggeredovert�mesofdayanddaysoftheweektomax�m�zethechancesofmak�ngacontactw�thapotent�alrespondent .Whenappropr�ate,�nterv�ewbreak-offsandrefusalswerere-contacted�nordertoattempttoconvertthemtocompleted�nterv�ews .
thewe�ght�ngofthesamplewasaccompl�shed�nthreestages:afirststagesampl�ngwe�ghttoadjustforthedes�gnedoversampl�ng�nm�nor�tyareas,asecondstageadjustmentforhouseholddemograph�csandath�rdstagewe�ghttoadjustperson-leveldemograph�cs .
oftheres�dent�alnumbers�nthesample86percentwerecontactedbyan�nterv�ewerand43percentagreedtocooperatew�ththescreenerquest�ons .Forty-s�xpercentwerefoundel�g�bleforthe�nterv�ew .Furthermore,87percentofel�g�blerespondentscompletedthe�nterv�ew .therefore,thefinalresponserate�s32percent .
Forresultsbasedonthetotalsample,onecansayw�th95%confidencethattheerrorattr�butabletosampl�ng�sw�th�napprox�matelyplusorm�nus3percentagepo�nts .errorforsub-groups�sl�kelytobelarger .Wheneverposs�ble,stat�st�callys�gn�ficantd�fferencesarenoted .thefollow�ngtablesprov�dedemograph�c�nformat�onaboutwomenages�8to64�ntheun�tedstates .
*includesas�an,Pac�f�cislander,amer�canind�an,alaskanat�ve,peopleofmult�pleracesandthosewho�dent�f�edthemselvesas“other .”
source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
55 to 6418%
45 to 5424%
35 to 4423%
25 to 3420%
18 to 2413%
Age Group
Other*7%
White66%
Latina14%
13% African American
Married58%
Living withPartner
7%Never
Married18%
Widowed,Divorced,Separated
18%
Race/Ethnicity Marital Status
FIguRe A
selected Demographic Characteristics of Women
note:�00%ofthefederalpovertythresholdwas$�7,600forafam�lyofthree�n2008 .sometotalsmaynotequal�00%duetoround�ng .*includesthosewhoared�sabled,studentsandunknownworkstatus .source:henryJ .Ka�serFam�lyFoundat�on,Kaiser Women’s Health Survey,2008 .
Unknown17%
300% to 399%of poverty
37%
200% to 299%of poverty
16%
100% to199%of poverty
20%
11%<100% of poverty
Poverty Level
College Graduate
29%
Post HighSchool
29%
High School
30%
12%High SchoolIncomplete
Education
Not employed
for pay26%
8%
6%
Retired
Other/Unknown
Employed,part-time
14%
Employed,full-time
45%
EmploymentStatus
FIguRe B
selected socio-economic Characteristics of Women
THE HENRY J. KAISER FAMILY FOUNDATION
Headquarters2400 Sand Hill RoadMenlo Park, CA 94025Phone 650-854-9400 Fax 650-854-4800
Washington Of�ces andBarbara Jordan Conference Center1330 G Street, NWWashington, DC 20005Phone 202-347-5270 Fax 202-347-5274
www.k�.org
This report (#8164) is available on the Kaiser Family Foundation’s website at www.k�.org.
The Kaiser Family Foundation is a non-pro�t private operating foundation, based in Menlo Park, California,dedicated to producing and communicating the best possible information, research and analysis on health issues.
Recommended