Gender bias and sex-based differences in health care efficiency in Polish regions

Abstract

Background: Health differences between sexes are relatively well recognized, though less is known about the specificity of women's and men's health responsiveness to medical care. Applying data from Polish regions, this study identifies sex-based differences in medical care efficiency and investigates the reasons for these disparities in the gender bias context.

Methods: The study estimates sex-specific health production functions for regional data from Poland (1999-2013). Using panel-data regression, male and female life expectancies at ages 0, 15, 30, 45, 60 and 65 are regressed on a set of socioeconomic factors, with the primary interest in medical care proxied by doctor density.

Results: The results show that in Poland the association between life expectancy and doctor density was positive for both men and women; however, the coefficients for medical care were insignificant for those at birth and at the age of 30 for both sexes. The magnitude of health care for longevity was higher for men comparing to women at every age, though the difference between sexes was not statistically significant. The sex-based disparities in medical care efficiency were more pronounced at younger ages and they diminished with age. The inspection of data on the health system in Poland shows that male patients seemed to be in an advantageous position: the mean reimbursement per service for men was higher in most medical care areas; men reported less problems with access to health care; and their mortality trend exhibited more favorable evolution over time. Additionally, the association between other socioeconomic factors and health also differed across sexes, and several of these factors were more important for life expectancy than health care.

Conclusion: Polish medical care suffers from gender bias, which possibly makes men more responsive to medical care. The disparities in the operation of medical care in Poland should be challenged to achieve more equal access to services between sexes and possibly to gain more health from the treatment of female patients.

Keywords: Doctor density; Gender bias; Health care efficiency; Health production; Life expectancy; Panel data.

Fig. 1

Sex- and age-specific elasticities of life expectancy with respect to health care. Source: own calculations based on [21]. Notes: Point and 95% confidence interval estimates

Fig. 2

Sex differences in average provider reimbursement rates from National Health Fund in 2009. Source: [23]. Notes: The reimbursement rate for women is the reference category. A positive (negative) value of percentage difference in reimbursement rate mean that the average reimbursement for men (women) was higher. "zl" is an abbreviation for zloty – Polish currency; the average 2009 exchange rate was 3.12 zlotys per 1 US dollar. In primary care doctors are reimbursed using capitation and the amounts are not diversified by gender. National Health Fund is a state institution that finances health care benefits provided for insured population

Fig. 3

Sex differences in self-rated health status and mortality rates between populations at various age. Source: own calculations based on [25]. Notes: Panel a shows percentage decline in share of respondents rating their health as very good or good with each consecutive age group. Panels b and c show percentage increase in mortality rates (number of deaths per 100.000 population) with each consecutive age group

Fig. 4

Share of respondents by reasons for not using doctors’ consultations despite being in need. Source: [28]. Notes: Data for ambulatory specialist care for 2006 and 2010 is missing. Panels a, b and c refer to services provided in primary care, dental care and ambulatory specialist care settings, respectively