Murasko Jason E
Indiana University South Bend, South Bend, IN, USA.
Soc Sci Med. 2006 Oct;63(7):1745-56. doi: 10.1016/j.socscimed.2006.04.030. Epub 2006 Jun 9.
Despite cardiovascular disease (CVD) being the leading killer of both sexes in the US, there are indications that men and women have different experiences in the health system with prevention and treatment practices. Beyond largely descriptive findings, little research exists that addresses how men and women may differ in their response to certain key influences on CVD health services utilization. This paper examines gender differentials in the effect of insurance coverage on CVD preventive health services in the US. An economics framework is used to model individual demand for preventive services as a function of insurance status, while controlling for a comprehensive set of explanatory variables. The services analyzed include cholesterol and blood pressure screening, pharmaceutical use for hypertension and lipid disorders, and CVD-related physician visits. Both general and high-risk samples are evaluated. The results show that while a lack of insurance is associated with lower rates of utilization in both men and women, there are no observed gender differences in insurance-effects for recommended intervals of risk factor screening in the general population. However, for individuals with previously diagnosed heart disease or stroke, a lack of coverage is more strongly associated with lower rates of screening, pharmaceutical management, and physician contact in women than men. Potential reasons for these findings are discussed and policy implications are noted.
尽管心血管疾病（CVD）是美国男女的首要死因，但有迹象表明，男性和女性在卫生系统中的预防和治疗经历有所不同。除了大量描述性研究结果外，很少有研究探讨男性和女性在应对某些对心血管疾病医疗服务利用的关键影响因素时可能存在的差异。本文研究了美国保险覆盖对心血管疾病预防保健服务影响中的性别差异。采用经济框架将个人对预防服务的需求建模为保险状况的函数，同时控制一系列综合解释变量。所分析的服务包括胆固醇和血压筛查、高血压和血脂异常的药物使用以及与心血管疾病相关的医生问诊。对一般样本和高危样本均进行了评估。结果表明，虽然缺乏保险与男性和女性较低的利用率相关，但在一般人群中，对于推荐的风险因素筛查间隔，未观察到保险效应方面的性别差异。然而，对于先前诊断患有心脏病或中风的个体，与男性相比，缺乏保险与女性较低的筛查率、药物管理率和医生接触率的关联更为强烈。讨论了这些发现的潜在原因并指出了政策含义。
