Women’s Health Care Chartbook - Kaiser Family Foundationthe data n th s chartbook descr be how women are far ng n the health care system, and w ll prov de a useful basel ne ... ,

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.

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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%) .


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


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


limits activity


treatment

Percentage of women ages 18 to 64 reporting:



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


limits activity


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


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%



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 .


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 .âmongwomenwhoaremarr�ed,l�v�ngw�thapartner,orhaveach�ldunder�8�nthehousehold .^âmongwomenwhoareemployed .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 ��


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 .



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


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 .


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



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


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 .


47%*

90%

86%

87%

90%*

67%*

90%

91%

71%*

84%

Uninsured

Medicaid

PrivateINSURANCE STATUS

Latina

African American

White

RACE/ETHNICITY


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:



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:


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



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%*



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 .


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



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%



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 .


AGE GROUP

POVERTY LEVEL

HEALTH STATUS

21%*

12%

13%

14%

18 to 44

45 to 64



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%



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) .


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



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�


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


CHAPTER 4:

Prevention and Screening


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



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



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


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%



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


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%


CHAPTER 5:

Access and Affordability


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�


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 .


HEALTH STATUS

RACE/ETHNICITY

Excellent to Good

Fair/ Poor

African American

White

Latina

POVERTY LEVELLess than 200% of poverty


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%*



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 .âmongwomenwhoareemployed .^âmongwomenw�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%*



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


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 .


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%



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


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



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%


Paid sick leave

68%

59%*

72%

Paid vacation

60%

42%*

68%

Disability insurance

65%

44%*

74%

Retirement plan



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


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



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:


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 .”


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

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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.

Documents

Women’s Health Care Chartbook - Kaiser Family Foundationthe data n th s chartbook descr be how women are far ng n the health care system, and w ll prov de a useful basel ne ... ,