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Building Effective Programs: Coping with the Patchwork Quilt of Women's Health Issues

Context & Framework


Carolyn Clancy, M.D., Director, Center for Outcomes and Effectiveness Research, Agency for Healthcare Research and Quality (AHRQ).

It is important to think of women's health as unique and distinct in terms of how health care is organized and delivered:

  • Women are more likely to be underinsured than men.
  • Many medical conditions are unique to women.
  • On average, women live longer than men and therefore experience more chronic conditions throughout their lifetime.
  • The type of health care women receive is influenced by non-clinical health determinants, such as race, level of education, and socioeconomic status.
  • Women's interactions with the health care system are characterized by fragmentation of services, poor communication with clinicians, and gender bias in receipt of treatment and services. While fragmentation of care is not limited to women, it is more pronounced.

The issue that needs exploring is, "To what extent can health care systems account for these characteristics and design programs to mitigate their negative effects on women's health?"

Data from The Commonwealth Fund's 1998 Survey of Women's Health indicates the following areas where there are opportunities for improvement, drawing upon:

  • Safety and violence at home was discussed in only eight percent of clinical encounters with women, sexually transmitted diseases in just 16 percent of encounters, and smoking in 29 percent of encounters.
  • Nearly 40 percent of women reported an experience during their lifetime of violence and abuse (including assault, battery, or rape by a spouse or partner, or physical/sexual assault or rape by anyone else, or physical/sexual abuse that occurred in childhood).
  • Women were more likely than men to report symptoms of depression or a physician's diagnosis of depression or anxiety.
  • The percentage of women receiving preventive health services was static between 1993 and 1998, with no increase in the number of women receiving clinical breast exams, mammograms (age 50 and older), Pap tests, or colon cancer screening (age 50 and older).
  • Women with low income were less likely to receive preventive care and more likely to experience the illnesses or conditions that can be avoided with regular preventive care.

Dr. Clancy presented the following opportunities as a framework for the future for policymakers to have an impact on women's health:

  • Improve prevention and screening services.
  • Reduce out-of-pocket costs.
  • Expand prescription drug coverage.
  • Ensure appropriate incentives for quality improvement.
  • Target efforts of improving care at low income and minority women.
  • Ensure access to appropriate providers, or develop a program to assure competence of providers to meet women's unique needs (core competencies).

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