Bridging the Health Care Divide: U.S. Women Face Stark Disparities Compared With High-Income Peers

Jayme Ambrose, DNP, RN, CCM

Women in the United States encounter significant health care disparities compared with their counterparts in other high-income countries.

Despite the U.S. spending more on health care than any other developed nation, many women face alarming challenges related to affordability, access and quality of care. These disparities contribute to poorer health outcomes and a higher prevalence of chronic conditions among American women.

Counting the Cost of Health Care Coverage

The U.S. stands out as an outlier among wealthy nations by not providing a universal health care system. While the Affordable Care Act (ACA) has made strides — enabling 7 million women to gain health insurance— many uninsured individuals still fall through the cracks. This is particularly true for low-income populations and those living in states that have not expanded Medicaid.

Research from the Commonwealth Fund highlights that a significant percentage of women in the U.S. lack health insurance, resulting in lower access to primary care providers. This gap places additional strain on emergency services, leading to the highest rates of unnecessary emergency room visits in the developed world.

Financial barriers also play a critical role in access to care. More than one-third of women in the U.S. report postponing necessary medical treatment due to costs — a rate significantly higher than that found in other high-income countries. Furthermore, more than 25% of women indicate spending more than $2,000 out of pocket on medical care for themselves or their families. Such financial constraints have profound implications for the prevention, diagnosis and management of serious health conditions among women.

Diagnosing Health Care Challenges for U.S. Women

Recent statistics paint a troubling picture for women’s health in the U.S. American women experience the highest maternal mortality rates among high-income nations, with racial disparities exacerbating these figures — Black women are three times more likely to die from pregnancy-related complications than their White counterparts.

Additionally, U.S. women have a lower life expectancy than those in other developed countries and face the highest rates of avoidable deaths. These disparities are particularly pronounced among American Indian, Alaska Native and Black women, who experience significantly lower life expectancies than their White, Asian and Hispanic peers. Factors such as socioeconomic status, lifestyle choices, education levels and access to health care services contribute to these inequalities.

The prevalence of chronic conditions is also concerning; U.S. women are statistically more likely to die from cardiovascular disease than those in other high-income countries. This underscores the urgent need for more detailed research into gender-specific risk factors for heart disease and greater emphasis on preventive screenings.

A New Policy Prescription for Women’s Health

To address these health inequalities, several interventions can be implemented. State-led initiatives have shown promise in reducing maternal mortality rates; California’s Pregnancy-Associated Mortality Review (CA-PAMR) program successfully reduced maternal deaths by 55% within a decade through public health initiatives and quality improvement measures.

In contrast to the U.S., maternity care in many high-income countries is typically free at the point of use, including postnatal care. These nations often provide care within primary and community-based settings, which not only reduces costs but also offers women a broader range of childbirth options.

Improving women’s health is crucial for fostering a healthier overall population and yielding societal benefits. The Commonwealth Fund suggests that expanding the ACA could significantly reduce preventable deaths and enhance health care outcomes for U.S. women. Their report advocates for comprehensive reforms that would allow all women access to affordable health care by enhancing marketplace subsidies and covering low-income individuals who fall into Medicaid’s coverage gap.

There is an urgent need for a comprehensive health care system that is inclusive and responsive to the diverse needs of women across various demographic groups. By reconfiguring our current treatment and delivery models, we can begin to bridge the health care divide faced by women in the United States.