By Elizabeth Hampson, Lead, European Deloitte Health Equity Institute, and Martha Kirk, Consultant, Monitor Deloitte

The Women’s Health Strategy for England, in August 2022, highlighted that while women generally live longer than men, they spend a greater proportion of their lives in ill health and that in many areas of healthcare, women experience poorer outcome.’ The Strategy acknowledged that: healthcare services have not been designed to meet women’ health needs; significant geographical and demographic inequities exist; women are under-represented when it comes to clinical research; and women’s voices are often not listened too.¹ Moreover, this ‘women's health gap' impacts most on women of working age. Reflecting on last week’s celebration of International Women’s Day seemed an appropriate opportunity to use this week’s blog to explore the results of a Deloitte Health Equity Institute survey of working adults in the UK and how disparities in healthcare services have led to differences between women and men’s out-of-pocket healthcare spend.   

About the research

Late last year, our Deloitte US Health Equity Institute published a report, ‘Closing the cost gap: Strategies to advance women’s health equity’. Based on an analysis by Deloitte’s health actuarial team of health insurance claims data, the report examined the impact that the average benefit design has on women’s’ out-of-pocket healthcare costs and found that employed women spend  $15 billion more per year than men.² Given this startling finding, and despite women in the UK having access to the NHS’s universal healthcare coverage which includes many but not all aspects of women’s healthcare needs, we wanted to understand whether women in the UK face a similar health cost gap in out-of- pocket spending.

We therefore conducted a survey with YouGov (of 1264 working women and 1308 working men) to investigate the extent of the gender healthcare spending gap in the UK. We also asked survey respondents how aware they are of women's workplace health benefits and how this influences their decision on retention and recruitment. Our analysis of the full survey can be found here.

Higher out-of-pocket health spend equates to working women spending £1.5 billion more on healthcare, per year, than men

We specified several categories of potential areas of out-of-pocket health and personal care spending (medical diagnostics and wearables; private counselling and other mental health support; general healthcare; and fertility, menopause and menstrual health) and asked survey respondents whether they had spent money in any or all of these categories in the last 12 months and, if so, how much. Our analysis of responses indicates that on average, women’s out-of-pocket spend is approximately £100, or 50 per cent, more per year than men (see Figure 1). Moreover, women spend more on average in each category of spend, with the largest difference, unsurprisingly, on fertility, menopause and menstrual health (250 per cent). Women also spent ten per cent more on medical diagnostics and wearables and 25 per cent more on general healthcare and on private counselling or other mental health support. This difference in out-of-pocket spending is indicative of a gender health gap.

Figure 1: Average spend by women and men across each healthcare category

Source: Deloitte Health Equity Institute 2023 analysis of the YouGov survey of 1264 working women and 1308 working men in the UK.

Question: ‘Have you spent money on any of the following health and personal care categories in the last 12 months (since October 2022)? If Yes, approximately how much did you spend in each category?’ Some 53 per cent of women and 39 per cent of men respondents answered the questions on level of spending.

As shown in Women’s Health Strategy for England, the women’s health gap can be attributed to:

• underinvestment in women’s health services
• women being misdiagnosed more and their pain ’taken less seriously’ in the healthcare system
• gaps in NHS data and evidence base that mean not enough is known about conditions that only affect women – for example, endometriosis - and also that not enough is known about how conditions that affect both men and women impact them in different ways – for example, cardiovascular disease, dementia or mental health conditions
• inefficiencies in how services are delivered, for example, we know that many women have to move from service to service to have their reproductive health needs met, and women can struggle to access basic services such as contraception
• under-representation of women in clinical trials and medical research, which leads to insufficient solutions tailored to women’s needs and poor women’s health literacy among some healthcare professionals.³

As a result, it’s unsurprising that women might need to seek specialist treatment at their own cost contributing to a higher overall out-of-pocket spending. Moreover, data suggests that the majority of the health gap is impacting women during their working years, between the ages of 20 and 60, not at the end of life.⁴ It’s not surprising, then, that our data shows respondents view companies that invest in women’s health positively.

Women are more attracted to companies that invest in women’s health benefits for their workforce

Given that evidence suggests that the majority of the health gap is impacting women during their working years, we explored survey respondents’ sentiment and attitudes regarding health benefits provided by employers.⁵

The majority of women (74 per cent) and men (61 per cent) either agreed or somewhat agreed that women’s health benefits demonstrate a company is serious about attracting and retaining female talent, highlighting an opportunity for employers to differentiate themselves in the fight for talent. Furthermore, 28 per cent of female respondents consider that employer’s women’s health benefits are a key factor in their decision to take or leave a job. However, most respondents (both men and women) disagreed with this statement overall, suggesting that it is not a deal-breaker.   

Additionally, women, particularly younger women, are more attracted to companies which invest in women’s health benefits for their workforce. Sixty per cent of women said they are more attracted to join companies that invest in women’s health benefits for their workforce (67 per cent of those aged 18-44 years). This indicates, the importance of benefits enabling women to balance reproductive health, career and family planning and maintaining health and wellness and that supporting women to improve their health is not only important for society, but a sound investment in the future of the workforce and overall economy.

Most employees aren't sure what to expect from their workplace in terms of supporting women’s health

Even though awareness of women’s health has improved, employees still don’t know what to expect from their workplace. Despite viewing women’s health benefits as an attractive benefit, a large proportion of women and men were not sure how they wanted their employer to better support them in the workplace outside of supportive time-off policies (see Figure 2).

Source: Deloitte Health Equity Institute 2023 analysis of the YouGov survey of 1264 working women and 1308 working men in the UK.

Question: ‘In which of the following ways would you like your company to support you and your colleagues’ needs better?’

Notes: [1] For example, time-off for fertility treatment, menstrual pain, menopause, etc. [2] For example, diagnostics, egg-freezing, fertility treatment, menopause treatment or support, etc.

How might gender-based disparities in health be addressed?

Addressing gender-based disparities in health requires a collaborative and multi-sectoral approach that involves action at the individual, community, institutional, and policy levels. By working together, stakeholders can help create a system that promotes equitable access to high-quality care for all individuals regardless of gender (see Figure 3).

Source: Deloitte Health Equity Institute 2023.

Conclusion

Our research indicates that 52 per cent of women resort to out-of-pocket spending on their health every year, compared to only 39 per cent of men and overall women spend £1.5 billion more on personal health and care than men. This suggests that women have more limited options in tackling their health needs and have no option but to fund these needs from out-of-pocket spending. While the recognition of these inequities is growing and the Women’s Health Strategy for England has identified a plan for the NHS to begin to address them, this will take time and it will also require collaboration and partnership to enable all women to meet their specific health needs. Our research suggests that as a priority, stakeholders should invest in and educate healthcare professionals on women-specific health conditions and also in ensuring they understand how and why women present differently to men. Most of all, it’s critical that women’s opinions are sought and their voices are heard.

Elizabeth Hampson, Partner, Monitor Deloitte

Liz is a Partner focused on life sciences and healthcare strategy and analytics. She leads projects that accelerate patient access to innovation, which includes health policy advisory and strategy projects with central government, industry, charities and payers in a range of countries. She is also a mental health champion.

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Martha Kirk, Consultant, Monitor Deloitte

Martha is a Consultant in Monitor Deloitte’s Life Sciences and Healthcare team. She holds an MSc in Philosophy from the London School of Economics, where she focused on theories of equality and gender, and has a keen interest in healthcare equality.

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1. Women's Health Strategy for England - GOV.UK (www.gov.uk)
2. Closing the Benefit Gap to Advance Women’s Health Equity | Deloitte US
3. Women's Health Strategy for England - GOV.UK (www.gov.uk)
4. WEF_Closing_the_Women’s_Health_Gap_2024.pdf (weforum.org)
5. https://www.weforum.org/agenda/2024/01/women-health-davos-2024/