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. 2021 Feb 24;39(1):3-10.
doi: 10.1159/000514798. eCollection 2021 Jul.

Explaining the Gender Gap in Waiting Times for Scheduled Surgery in the Portuguese National Health Service

Joana Cima  1 , Paulo Guimarães  1   2 , Álvaro Almeida  1   2
Affiliations

Explaining the Gender Gap in Waiting Times for Scheduled Surgery in the Portuguese National Health Service

Joana Cima et al. Port J Public Health. .

Abstract
in English, Portuguese

Objective: This paper evaluates the gender gap in waiting times for scheduled surgery, using information on 2.6 million surgical episodes in Portuguese National Health Service hospitals covering the period from 2011 to 2015.

Methodology: We estimated the gross gender gap, i.e., the differential between the waiting times of men and women, and then add several explanatory variables that can account for this difference to estimate an adjusted gender gap. The variables are added in a way that permits the most flexible parametric specification. Next, we used Gelbach's decomposition to understand the contribution of each variable to the difference between the gross and the adjusted gender gaps.

Results: The gross gender gap of 10% is reduced to a 3% adjusted gender gap after accounting for observable explanatory factors. Gelbach's decomposition shows that patient priority and hospital-fixed effects are the variables that contribute the most to the explained component of the gap. The analysis suggests that men tend to be ranked with more severe priorities, and that there are hospital specificities that cause men to have shorter waiting times.

Conclusions: Overall, we identified a gender bias against women in surgery waiting times, but the size of the bias is smaller than was previously suggested in the literature.

Objetivo: Este trabalho avalia a diferença de género nos tempos de espera para cirurgias programadas, usando cerca de 2.6 milhões de observações sobre os episódios cirúrgicos que ocorreram nos hospitais do Serviço Nacional de Saúde Português entre 2011 e 2015.

Metodologia: Estimamos o diferencial bruto entre géneros nos tempos de espera, e depois adicionamos variáveis de controlo que expliquem a diferença para estimar um diferencial ajustado. As variáveis são adicionadas de maneira a permitir uma especificação paramétrica mais flexível. Em seguida, usamos a decomposição de Gelbach para entender a contribuição de cada variável para a divergência entre os diferenciais de género bruto e ajustado.

Resultados: O diferencial bruto de 10% entre géneros é reduzido para um diferencial ajustado de 3% depois de considerado o efeito das variáveis explicativas observadas. A decomposição de Gelbach mostra que a prioridade do paciente e os efeitos fixos hospitalares são as variáveis que mais contribuem para a componente explicada da diferença. A análise sugere que os homens tendem a ser classificados com prioridades mais severas e que existem especificidades hospitalares que fazem com que os homens tenham tempos de espera mais curtos.

Conclusões: No geral, os nossos resultados identificam um viés de género contra as mulheres, mas a dimensão do viés é menor do que sugerido pela literatura anterior.

Keywords: Gelbach's decomposition; Gender gap; Portugal; Scheduled surgery; Waiting times.

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Conflict of interest statement

The authors declare there are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Median waiting times (days) for surgery between 2011 and 2015.
See this image and copyright information in PMC

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