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The Hidden Toll: Unraveling the Gender Health Gap and Rethinking Health Insurance as Preventive Care

Health Insurance vs Sick Insurance

If you have ‘health insurance’ you have made a choice for sick care and there's nothing wrong with that. You never know if you'll have an accident, injury or unexpected health issue and it is important to have coverage for yourself and your family.

However, this terminology can be misleading as it implies that the focus is on maintaining good health and preventing illnesses. In reality, modern healthcare systems tend to be more reactive than proactive, with a greater emphasis placed on treating illnesses rather than preventing them. This is why health insurance may be more accurately described as sick care insurance rather than health insurance.


To achieve actual prevention, it is necessary to invest in a separate set of interventions that focus on keeping people healthy and addressing the root causes of health problems before they become serious. This can include services such as preventative medical screenings, health coaching and lifestyle interventions. Current health insurance does not cover these preventive services. Many are taken by surprise since you need a diagnosis (which means you are already sick or have a disease) to be eligible to claim reimbursement.



Healthcare Crisis

Preventive care may also involve public health initiatives such as health awareness campaigns, flu vaccines and subsidised screening and treatment services for breast cancer or menopause hormone therapy.

These public health initiatives can help meet the gap not met by private insurance, especially those that do not cover medical services for women's health and menopause therapies. (Unfortunately, to date there are no personal private health insurances that cover menopause therapies as it is considered either "Anti-aging" or "A natural physiological process" like pregnancy, and therefore, optional).


With global shortages in medical doctors and health providers combined with an aging population, there is a serious healthcare crisis in the public sector.


In the US, around 1 in 4 doctors are considering leaving their profession. And this is surprisingly not a purely COVID-related phenomenon. 89% cite burnout as the main cause and 40% say they lack the resources to operate at full potential. It is estimated that there will be 38,000-124,000 physicians short by 2034.

In Hong Kong, there are 1.9 doctors for every 1000 people, which is well below the OECD (Organisation for Economic Cooperation and Development) of 3.4 and lags behind international peers such as Singapore at 2.4. Hong Kong needs an extra 3,000 doctors to be in line with Singapore and 10,000 to catch up with other well-developed countries.



What you need to know as a patient

This is where, as a patient, and especially if you are a woman, you need to be aware of the health gaps that exist in a medical system that neither supports the health providers nor preventative holistic healthcare.

  1. Mainstream consultations are not equipped for a holistic or lifestyle approach as consultation times are capped at managing symptoms, specific conditions or review of treatment. A systemic review of primary care consultation times conducted across 67 countries in 2017, reported a range between 48 seconds to 22.5 minutes. The study included public and private clinics and concluded that with only a few minutes allocated to consultations, they are likely to affect patient health outcomes and physician workload stress. This is a global issue that will need a village to address and not the fault of your primary care provider.

  2. Even with private health insurance, lifestyle advice or interventions that require more consultation time; and despite being the first line for managing chronic conditions such as heart disease, diabetes and obesity, are challenged by the insurer which adds to the health providers' administrative costs outside of clinical hours.

  3. A survey of 2 urban cities in Beijing found that the average consultation times were 2 minutes. Over 80% of these were for prescriptions and only 17.7% were for health and disease education.

  4. Consultation fees differ across private clinics and some will charge according to the time spent per visit with a wide variation in cost structure depending on supply and demand for services. For example, 15 min, 30 min or 45 min may be allocated times. Make sure that you have factored in sufficient time for your concerns. If your list is long, you may need further visits and you should discuss this with the doctor during the initial consult.

  5. Have a list of health priorities that you want to address, which ties in with the point above, especially if you are experiencing multiple issues. Make sure that you also check if your insurance is covering preventive screening. If not there may be public health clinics that do this.

  6. Private health insurance in some countries such as Hong Kong does not cover menopause symptoms. It also does not cover administrative fees including letter writing for insurance claims or travel health reports. This becomes an out-of-pocket expense for women, which further contributes to the gender-health gap. However, there are government-subsidised clinics that provide menopause services, which you can be referred to. But you do not have a choice in the doctor that you see and appointment time options are limited. With the staff shortages and growing demand for health services with an aging population, waiting times can be long.

  7. The average government-funded outpatient clinic consultation times on average are 6.7min, to make the most of the time ensure that you have specific records of your symptoms, past health history and a list of medications if you take any so that the doctor can determine if there are interactions with your medical condition and other drugs.


Another important area to consider apart from the changes needed to take place in the health care system is the socioeconomic determinants of health.


Socioeconomic determinants of health refer to the social and economic factors that influence an individual's health status and well-being. These determinants are not solely determined by an individual's biology or personal choices but are shaped by the social and economic conditions in which people live, work, and age. They play a crucial role in health outcomes and health inequalities within populations.


Some key socio-economic determinants of health include:

  1. Income and Wealth: Higher income and wealth are generally associated with better health outcomes. Individuals with lower incomes may face challenges in accessing healthcare, nutritious food, safe housing, and other resources that are essential for good health.

  2. Education: Education is closely linked to health. Higher levels of education are generally associated with better health outcomes and a lower risk of chronic diseases. Education equips individuals with the knowledge and skills to make informed health choices and access better job opportunities and income.

  3. Occupation and Employment Conditions: The type of work an individual engages in and the conditions in which they work can impact their health. Jobs that involve physical labour, exposure to hazards, long working hours, or low job security can increase the risk of occupational injuries, stress, and adverse health effects.

  4. Social Support and Networks: Strong social support systems, such as family, friends, and community networks, contribute to better health outcomes. Social connections provide emotional support, reduce stress, and promote healthier behaviours.

  5. Housing and Neighborhood: Living in safe, affordable, and healthy housing conditions is vital for good health. Neighborhood characteristics, such as access to parks, clean air, and healthy food options, can significantly influence health outcomes.

  6. Environmental Factors: Environmental determinants, such as air and water quality, exposure to pollutants, and access to green spaces, can impact health. Poor environmental conditions increase the risk of respiratory and cardiovascular diseases, among other health problems.

  7. Social and Economic Policies: Broader social and economic policies, including income support programs, minimum wage laws, and social welfare systems, can influence health outcomes. Policies that promote income equality, social inclusion, and equitable access to resources contribute to better population health.

It's important to recognize that these determinants are interconnected and mutually reinforcing. Addressing socio-economic determinants of health requires comprehensive approaches that tackle systemic inequalities and promote equitable access to resources and opportunities for all individuals and communities.



Challenges and Potential Solutions

In summary, while health insurance is an important component of our healthcare system, it is insufficient to address the complex challenges of maintaining good health. Actual prevention requires a proactive decision to invest in a separate set of interventions that prioritise keeping people healthy and addressing the root causes of health problems.

Currently, neither tax-funded healthcare nor private health insurance are bridging gaps that allow health providers to manage health holistically. This is worsened by the shortages of health providers as many are leaving due to burnout from poor working conditions and growing administrative duties that distract from clinical work that has to be addressed at institutional levels.

It has become even more urgent that health education is accessible so that individuals can be empowered to advocate and navigate the medical system. There is potential for shared medical appointments (SMA) to provide lifestyle education, advice and interventions for chronic conditions such as diabetes, heart disease, obesity, smoking cessation and menopause care. It is a non-traditional and innovative approach to patient-centred care that increases doctor-patient contact time, greater education, enhanced prevention and disease self-management and accountability for health behaviour change. There are various forms of SMAs and although currently no gold-standard format, systemic reviews have shown this to be promising for the management of lifestyle-related chronic conditions, pregnancy care and menopause which are taking place in well-developed health systems.


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For more information on evidence-based medical and lifestyle strategies for women's health, longevity and group medical visits, you can contact us via Email or WhatsApp


References:

1. Irving G, Neves AL, Dambha-Miller H, Oishi A, Tagashira H, Verho A, Holden J. International variations in primary care physician consultation time: a systematic review of 67 countries. BMJ Open. 2017 Nov 8;7(10):e017902. doi: 10.1136/bmjopen-2017-017902. PMID: 29118053; PMCID: PMC5695512.

2. Jin G, Zhao Y, Chen C, Wang W, Du J, Lu X. The length and content of general practice consultation in two urban districts of Beijing: a preliminary observation study. PLoS One. 2015 Aug 10;10(8):e0135121. doi: 10.1371/journal.pone.0135121. PMID: 26258911; PMCID: PMC4530861.

4. Healthcare Service in Hong Kong and its Challenges

The Role of Health Professionals within a Social Model of Health. Veronika Schoeb. p. 51-58

5. A Treatment For America's Healthcare Worker Burnout: https://www.bain.com/insights/a-treatment-for-americas-healthcare-worker-burnout/

6. Health System Capacity Constraints-The Severe Shortage of Doctors in Hong Kong Public Hospitals: https://www.ourhkfoundation.org.hk/sites/default/files/media/pdf/ManpowerPPT_20190410_full_eng.pdf

8. Wadsworth, K.H., Archibald, T.G., Payne, A.E. et al. Shared medical appointments and patient-centered experience: a mixed-methods systematic review. BMC Fam Pract20, 97 (2019). https://doi.org/10.1186/s12875-019-0972-1

9. Menopause Group Visits Provide Time For Questions And Information: https://fpscbc.ca/content/menopause-group-medical-visits-provide-time-questions-and-information



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