Gender disparities in cardiovascular care have been documented in studies of patients, but little is known about whether these disparities persist among managed health care plans. This study examined 1) the feasibility of gender-stratified quality of care reporting by commercial and Medicare health plans; 2) possible gender differences in performance on prevention and treatment of cardiovascular disease in US health plans; and 3) factors that may contribute to disparities as well as potential opportunities for closing the disparity gap.
We evaluated plan-level performance on Healthcare Effectiveness Data and Information Set (HEDIS®) measures using a national sample of commercial health plans that voluntarily reported gender-stratified data and for all Medicare plans with valid member-level data that allowed the computation of gender-stratified performance data. Key informant interviews were conducted with a subset of commercial plans. Participating commercial plans in this study tended to be larger and higher performing than other plans who routinely report on HEDIS performance.
Nearly all Medicare and commercial plans had sufficient numbers of eligible members to allow for stable reporting of gender-stratified performance rates for diabetes and hypertension, but fewer commercial plans were able to report gender-stratified data on measures where eligibility was based on recent cardiac events. Over half of participating commercial plans showed a disparity of ≥5% in favor of men for cholesterol control measures among persons with diabetes and persons with a recent cardiovascular procedure or heart attack, whereas no commercial plans showed such disparities in favor of women. These gender differences favoring men were even larger for Medicare plans, and disparities were not linked to health plan performance or region.
Conclusions and Discussion
Eliminating gender disparities in selected cardiovascular disease preventive quality of care measures has the potential to reduce major cardiac events including death by 4,785–10,170 per year among persons enrolled in US health plans. Health plans should be encouraged to collect and monitor quality of care data for cardiovascular disease for men and women separately as a focus for quality improvement.
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Ann F. Chou, PhD, MPH, is an Assistant Professor in the Department of Health Administration and Policy at the University of Oklahoma College of Public Health and College of Medicine. She is a health services researcher whose interests focus on implementation of best practices and quality of care.
Lok Wong, MHS, is currently a Health Policy doctoral student at Johns Hopkins Bloomberg School of Public Health and previously Senior Health Care Analyst at the National Committee for Quality Assurance. Her work has focused on quality of care among vulnerable populations and development of performance measures.
Carol S. Weisman, PhD, is Professor of Health Evaluation Sciences and Obstetrics and Gynecology at the Pennsylvania State University College of Medicine. She is a sociologist and health services researcher whose research focuses on women’s health, health care, and health policy.
Sophia Chan, PhD, is currently pursuing a master’s degree in public health at the Johns Hopkins Bloomberg School of Public Health. Her previous work has focused on survey design and analysis.
Arlene S. Bierman, MD, MS, holds the Ontario Women’s Health Council Chair in Women’s Health and is Associate Professor of Medicine; Health Policy, Management and Evaluation; and Nursing at the University of Toronto and Senior Scientist at the Centre for Inner City Health Research, St. Michaels Hospital, Toronto. Her research focuses on improving quality and outcomes of care for older adults with chronic illness.
Rosaly Correa-de-Araujo, MD, MSc, PhD, is the Director of the Office of the Americas, Office of Global Health Affairs and a cardiovascular pathologist trained at the National Heart, Lung, and Blood Institute. Her main areas of interest include gender-based research and analysis particularly related to chronic diseases, medication use outcomes and safety, and disparities in health care.
Sarah Hudson Scholle, MPH, DrPH, is Assistant Vice President for Research at the National Committee for Quality Assurance in Washington, DC. She is a health services researcher, and her current research focuses on quality measurement, women’s health, and disparities.
Published online: May 10, 2007
Accepted: March 22, 2007
Received: January 12, 2007
© 2007 Jacobs Institute of Women’s Health. Published by Elsevier Inc. All rights reserved.