High Costs Undermine Women's Health

A new survey by the Kaiser Family Foundation finds that many women are not going to the doctor or failing to fill prescriptions because of costs. Host Jennifer Ludden talks with Kaiser's Alina Salganicoff about the findings.

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JENNIFER LUDDEN, host:

A new survey out this week finds that a growing number of American women are not going to the doctor or not filling prescriptions because they can't afford it. The Kaiser Family Foundation surveyed more than 2,700 women. It found most women are in good health and satisfied with their medical care, but there are troubling signs for those with no health insurance or in failing health. Alina Salganicoff if vice president and director of Women's Health Policy at the Kaiser Family Foundation and she joins us from member station KQED in San Francisco.

Welcome.

Ms. ALINA SALGANICOFF (Kaiser Family Foundation): Thank you.

LUDDEN: So in your survey here, how many women did you find are foregoing a doctor's visit or prescription drugs because of cost?

Ms. SALGANICOFF: We found about one in four women actually reported that they either delayed or went without care they thought that they needed because of costs, and about one in five women said that they didn't fill a prescription because of costs.

LUDDEN: Now are we talking about uninsured women or both those with and without health insurance?

Ms. SALGANICOFF: This problem was not just a problem for uninsured women. We actually found that 17 percent of women with private insurance coverage also reported that they either went without or delayed care because of cost.

LUDDEN: So whatever percentage they would have had to pay was still too much.

Ms. SALGANICOFF: Right. That posed a barrier to their care.

LUDDEN: Now is this an increase in recent years?

Ms. SALGANICOFF: Yes. We did this survey in 2001 for the first time and then repeated it in 2004. It is a slight increase, but it's a notable increase because it's very hard, you know, a three-year period to find changes like this.

LUDDEN: What do you mean?

Ms. SALGANICOFF: Well, often you don't really notice very many changes. In a three-year period, there haven't been very many changes in the health-care system. One of the changes that we have noted through other research is that increasing costs are borne now among workers and their families in terms of out-of-pocket costs and this is now playing out in terms of we're seeing increased numbers of women are also delaying care because of costs.

LUDDEN: Is that why you think you're seeing this increase, that companies can't pay as much for health insurance for their employees?

Ms. SALGANICOFF: Right. I think that it's a shift from the premium cost. Now people are paying more in terms of deductibles. People are paying more in terms of co-pays and cost sharing. Your cost sharing for prescription drugs has also risen as well. There's a lot of other evidence that shows that, and what this survey really shows is that it's having an impact on accessing health-care services.

LUDDEN: Now Medicaid covers health-care costs for many of the poorest Americans, but we're seeing now a number of states looking to cut their Medicaid rolls. What effect would you expect that to have on the number of women foregoing care?

Ms. SALGANICOFF: Well, three-quarters of the adult Medicaid population is women, so I think that if you see cutbacks in eligibility or increases in cost sharing or co-pays, you may see that the poorest women have trouble accessing care because the cost is definitely going to be a barrier for them. If they don't have coverage, they're definitely going to limit their care, and if they have co-pays with Medicaid, that could really pose a problem for them as well.

LUDDEN: What else did you find in this survey of women?

Ms. SALGANICOFF: One of the things that we looked at is women's experiences with the health-care system once they get in, and what we found rather surprised us which is that very many of the preventive services and counseling services that we are now recognizing are important for women are not discussed during the medical visit.

LUDDEN: And is this something one would expect the doctor to bring up or should women be told to bring these things up and what kinds of issues are you talking about?

Ms. SALGANICOFF: Well, basic issues such as diet, exercise, smoking, alcohol abuse, exercise--these are all issues that we recognize are really important to health care. They're not being raised in the medical visit. Often there's not time. The women need to recognize that they are partners. The doctors are not always going to have time to ask them. Physicians also need to take advantage of the educational opportunity that a medical visit is for women to learn about how they can improve their own health care.

LUDDEN: Alina Salganicoff is vice president and director of Women's Health Policy at the Kaiser Family Foundation.

Thank you.

Ms. SALGANICOFF: You're welcome.

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