Women are more likely than men to avoid care. Here’s how hospitals can help.

Forget any preconceptions that men are more likely to skip a visit to the doctor.

Many women are choosing to avoid or delay healthcare visits because of the cost, says Dr. Kulleni Gebreyes, MD, of Deloitte.

Half of all women (50%) say they have avoided or delayed taking care of healthcare needs, according to a new analysis released this morning by Deloitte. Women are 35% more likely to postpone or skip healthcare visits than men, the report states.

Many women are choosing to avoid care because of the cost, says Dr. Kulleni Gebreyes, MD, Deloitte’s U.S. consulting life sciences & healthcare leader and chief health equity officer. She is one of the authors of the report.

“First and foremost is affordability, and as you can imagine, affordability means having the available income to pay your co-pays, to pay for your medicines, etc.,” Gebreyes says. “So one big reason that we're seeing women defer care is because they just simply can't afford it.”

There’s a gender gap when it comes to cost as an issue in seeking care. Women are 31% more likely than men to skip care due to the cost.

In an interview with Chief Healthcare Executive®, Gebreyes discusses the barriers to care for women, including affordability, access and shoddy treatment from providers. She also outlines steps hospitals can take to make it easier for women to get the care they need.

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Affordability issues

Women are twice as likely as men to miss medical appointments due to transportation issues, the Deloitte analysis found.

At the same time, affordability and access are often linked, Gebreyes says.

As Gebreyes says, “Can they afford to put gas in the car? How far away is the provider and how far do they have to travel? Is there public transportation? Can they walk there?”

The report cited three types of care that women delay or avoid due to cost issues: dealing with an illness (the cold or flu), preventive care, and women’s health issues.

Women also spend more money on healthcare costs than men, and that makes it harder for them to keep up with healthcare needs. Women typically spend $266 more on their out-of-pocket health costs than men, according to an October 2023 report by Deloitte.

Gebreyes also points out that women end up paying a “pink tax,” as they see higher costs for products that are marketed for women.

Plus, women typically earn less than men, also straining their ability to keep up with screenings or go to the doctor when they’re sick. Women make about 80 cents for every dollar men make, and Black women and Hispanic women earn less.

“Women are also likely to defer pain for medications they've been prescribed, and foregoing that kind of circles back to the cost issue,” Gebreyes says.

Many women don’t have an extra $500 for unexpected medical costs, she notes.

Poor treatment

Some women skip seeing a physician due to a bad experience with a provider, the report finds.

“You go to a retail store and you don't get treated very well, you're less likely to go back,” Gebreyes says. “And so what the data shows us, both our research and others, is that, if women experiencing care are being dismissed, their symptoms ignored, maybe even sometimes blamed and not believed for what they're expressing … they don't go back, because they don't have a good experience.”

In some cases, unconscious bias could be a factor in women not getting the care they need. Gebreyes worked in an emergency department for a decade, and she says men and women sometimes express their symptoms in different ways.

“People express pain differently,” she says. “They express symptoms differently, and so if it doesn't fit the mental model that maybe a clinician has on how to process that information, and they see some anxiety that a woman expresses, they might just assume that the symptoms are a result of the anxiety or imagined.”

Gebreyes also points to more systemic issues, including the need for more women to be enlisted in clinical trials. Researchers and physicians have noted that women are underrepresented in studies of heart disease.

“If you look disproportionately across our history, women have not been included in studies that look for insights on how to diagnose and treat, and so the pattern recognition and the evidence base that we have is based on the physiology and biology of men,” Grebeyes explains. “So women present and experience symptoms differently, disease conditions show up differently, and we just don't have the evidence base to recognize it.

“So you've got those two things coming together for the woman who's seeking care … just makes her feel potentially ignored and dismissed,” she says.

What hospitals can do

Hospitals and health systems can make it easier for women to get healthcare, she says.

As Gebreyes says, “It’s absolutely critical to look at it from the lens of the consumer or the patient, to say, do we need mobile vans to come into the neighborhood? Do we need sites of care that are close to public transportation?”

Hospitals and health systems need to understand who they are serving, and the barriers that may exist in certain neighborhoods, she says. Health systems may need to adjust the hours of operations of some clinics for women who can’t get to appointments during typical workday hours.

“Alternative sites of care are absolutely important,” she says.

The study shows that women are 50% more likely than men to skip care due to long wait times. Those long waits can be more problematic for women with small children, especially if they’re handling the brunt of family responsibilities. If women can’t find someone to watch the kids, they may skip the visit to the doctor.

Health systems that are looking to improve access for women should consider offering more telehealth options, Gebreyes says.

Four of five women (80%) who said they have engaged in a telehealth appointment cited convenience and access. Nearly half (45%) said telehealth options offered more convenient appointments.

“The great thing about telehealth business and virtual visits is that making care more accessible is good for women, but it's good for everyone,” Gebreyes says.

Expanding virtual options can also expand options for women, and men, in rural neighborhoods and areas without easy access to public transportation.

Women tend to have more appointments than men, such as screening for breast cancer and gynecological visits, so health systems could also offer more options to cluster different appointments for patients.

Women who delay care often face more serious health complications down the road, and even greater costs. Women are often four years older than men when they are diagnosed with the same diseases, the report states.

“When you skip the preventative care for breast cancer, colon cancer, cardiac testing, you're going to have a delay in diagnosis because … the healthcare system hasn't been able to catch the early warning signs,” Gebreyes says.