Deloitte Analysis: Employed Women Have as Much as $15.4 Billion More in Out-of-Pocket Medical Expenses a Year Than Men

Deloitte health actuaries found women not only generally have more out-of-pocket medical expenditures than men but get less coverage for every health insurance premium dollar spent

NEW YORK, Sept. 26, 2023 /PRNewswire/ --

Key takeaways

• Employed women have as much as $15.4 billion more a year than men in out-of-pocket health care expenses.
• At all ages between 19 and 64, women have more in average out-of-pocket health care expenses than men, excluding maternity claims.
• For people with commercial insurance, the value of benefits for women is more than $1.3 billion less than men.
• The cost to employers to cover this actuarial value gap is less than $12 per employee or less than $1 a month.

Why this matters 
While women and men tend to buy the same health insurance products, Deloitte health actuaries found the coverage they receive is generally not the same. To understand potential financial discrepancies of health benefits, Deloitte's health actuarial team examined more than 16 million people under employer-sponsored coverage to understand the impact of benefit design on out-of-pocket financial costs for women compared to men. The report, "Hiding in plain sight — the health care gender toll," revealed that based on current benefit coverage, women's out-of-pocket costs are disproportionately higher than men's for every age from 19 to 64, even when excluding pregnancy-related services. The report recommends health insurers and employers examine and redesign benefit coverage to reduce the financial gap experienced by women and help drive health equity and optimal health and well-being for all people.

Differences in health care consumption don't explain differences in costs
Deloitte's analysis validated that men and women generally consume health care differently. Overall, women seek more health care and more treatment than men, and this utilization difference holds true even when excluding maternity claims. The analysis found that while women experience 10% more in total health expenditures relative to men, it did not explain why out-of-pocket expenditures for women are 18% higher than men. The analysis found:

• Women more often encounter medical services that surpass the typical deductible, leading to higher out-of-pocket payments.
• Women tend to reach their out-of-pocket maximums more frequently than men.
• On average in 2021 for all claims reviewed, women (from ages 19 to 64) paid 20% more than men in out-of-pocket expenditures. Removing all relevant maternity claims only closed this difference in out-of-pocket spend by less than 2%.
• Forty-six percent (46%) of men have less than $1,000 in claims compared to 35% for women.

Several factors were found to contribute to the difference in health care utilization patterns, including early-age recommendations for annual check-ups, greater frequency of gynecological examinations, the relatively high cost of breast cancer imaging compared to other cancer types, and the effects of menopausal transitions, among various others.

Key quote

"Our analysis highlights a hidden financial burden on women that can not only impact their pocketbook but potentially their health. Financial stressors can lead to health problems and delays in care which can further perpetuate a cycle of preventable health care consumption thus compounding expense. As leaders in business, health care, and society, we have an opportunity to make intentional efforts to close this gap."

—Kulleni Gebreyes, M.D., U.S. chief health equity officer and life sciences and health care sector leader, Deloitte Consulting LLP

Women's billion-dollar burden coupled with lower benefits value
Deloitte's analysis revealed that the $15.4 billion burden on women was not the result of maternity claims. The findings indicated the actuarial value of benefits — the ratio of average coverage provided by the insurance carrier for the population — was lower for women compared to men in aggregate. This held true whether maternity claims were included or excluded from the analysis. Notably, the benefits were consistently lower for women across all age groups except for the ages between 30 and 51. This age range corresponds to the latter portion of women's childbearing years, perimenopause and menopause. As women are hitting their deductibles more frequently during these stages of life, it's expected that their actuarial values would be higher. Nevertheless, beyond these years, a trend emerges when observing women's lifespans in their entirety — women consistently derive lesser value for each health care premium dollar spent.

Key quote

"Our health care system has done a great job driving equity for access, from the ACA making pregnancy an essential health benefit, to rules around Mental Health Parity. Equity in benefits is the next challenge to address because benefits should be designed to support every person. Women's care needs are different than men, and health care insurers and employers have an opportunity to examine and redesign benefit coverage to reduce the financial burden on women, close the benefit gap, and advance health and well-being for everyone."

—Andy Davis, principal, health care practice, Deloitte Consulting LLP

Health care insurers and employers can close the gap
Based on this analysis, Deloitte recommends an intentional review of benefit design coverage with focused analysis of impact on men, women and individuals of any gender. Employers possess the ability to close this $15.4 billion expenditure gap — at the approximate cost of $133 per enrolled employee annually — potentially creating financial equity in their health care benefit. Full recommendations can be found in the report.

About the analysis
The methodology employed in our study involved the utilization of health insurance data from the Komodo Healthcare Map™. This dataset encompasses enrollment history and healthcare claims for both pharmacy and medical benefits from all settings of care sourced from payers nationwide from 2017 to 2022.

Within the Komodo database, we accessed information pertaining to the type of service received based on codes (DRG, CPT, HCPC, ICD-10, NDC), the place of service (Inpatient, Outpatient, Professional, Pharmacy), and the total medical allowed amounts. We categorized by gender included in the Komodo Healthcare Map™ (male or female) and age. The analysis performed included and excluded maternity-related claims. In all scenarios, the analysis excluded preventative services from any medical patient responsibility. We analyzed the data against the average commercial benefit design for single coverage using continuance tables applied to each member included in the analysis.

About Deloitte
Deloitte provides industry-leading audit, consulting, tax and advisory services to many of the world's most admired brands, including nearly 90% of the Fortune 500® and more than 8,500 U.S.-based private companies. At Deloitte, we strive to live our purpose of making an impact that matters by creating trust and confidence in a more equitable society. We leverage our unique blend of business acumen, command of technology, and strategic technology alliances to advise our clients across industries as they build their future.  Deloitte is proud to be part of the largest global professional services network serving our clients in the markets that are most important to them. Bringing more than 175 years of service, our network of member firms spans more than 150 countries and territories. Learn how Deloitte's approximately 475,000 people worldwide connect for impact at www.deloitte.com.

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SOURCE Deloitte