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More targeted efforts are needed to improve women's
According to Carolyn M. Clancy, M.D., Director of the Agency for Healthcare Research and Quality's Center for Outcomes and Effectiveness Research, future efforts to improve the health care provided to women should focus on three areas: coordination of care, interaction with the health care system, and the relationship between socioeconomic status and health. Another priority is finding ways to maintain and, when possible, enhance the functional status and independence of older women.
Women live longer than men, but they spend more years being disabled, notes Dr. Clancy. In a recent book chapter, she points out that the separation of reproductive from "all other" health needs has often meant that women have had to cope with a health care system that has not been organized to provide coordinated, woman-centered care. A substantial number of women have chosen to obtain care from more than one doctor, which creates redundancy or gaps in care.
What's more, medical services are often provided differently to women than men. For instance, women are less likely to receive costly, high-technology medical services than men. Also, care for conditions unique to women—such as childbirth and breast cancer—often varies depending on geography and socioeconomic status. Before 1980, women were often underrepresented in clinical trials, so the knowledge base to guide clinical decisions is underdeveloped in many areas of women's health. Also, the existence and generosity of insurance coverage is closely linked with employment and social status, which may place women at risk of undertreatment.
Fortunately, changes in medical education and health care delivery offer great promise in alleviating some of these problems, says Dr. Clancy. Since 1969, the family medicine specialty has trained physicians who can provide both general and gynecologic care, and internal medicine training programs are now required to include training in primary care gynecology. Since 1995, residency programs in obstetrics-gynecology have included a nonreproductive primary care component. And finally, the number of female physicians is increasing, with a nearly equal number of men and women beginning medical school in 1999.
More details are in "Gender issues in women's health care," by Dr. Clancy, in Women and Health edited by Marlene B. Goldman and Maureen C. Hatch. New York: Academic Press, 1999, pp. 50-54. Reprints (AHRQ Publication No. 00-R010) are available from the AHRQ Publications Clearinghouse.
Editor's Note: Identification of health services research issues of particular relevance to women is of great interest to AHRQ's cross-cutting initiative on women's health. For additional information on funding opportunities related to women's health services research, please visit our Funding Opportunities page or contact Rosaly Correa-de-Araujo, Senior Adviser for Women's Health, at (301) 427-1550 or RCorrea@ahrq.gov.
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