Closing the gender gap: Achieve health equity with data and a plan  

While this decade has been marked by tumultuous events like the COVID-19 pandemic, global inflation and labor shortages, from an employee benefits perspective the 2020s has also been a time of progress, when, more than ever before, employers are prioritizing the goal of equity. Recognizing that gender, race, ethnicity, and other factors can affect access to care and health outcomes, many have begun taking action to improve the opportunities for all plan members to attain their optimal health. 

Uncovering the gender gap with data and analytics

One reason that health equity is getting more attention than in the past is due to advances in information technology and our enhanced ability to identify problems and support initiatives by sifting through and analyzing large amounts of data (which, as an actuary, I can’t help but get really excited about). With International Women’s Day approaching, let’s explore an example in which we analyze a population based on gender. Each year since 2018, using data from Mercer’s annual National Survey of Employer-Sponsored Health Plans, we have created a group of employers with a predominately female workforce (65% or more female) and a similar-sized group of employers with a predominantly male workforce (65% or more male). We then compare benefits and policies across these two groups. It’s important to note that the majority of the mostly female companies are in the health care and services sectors, while the majority of mostly male companies are in manufacturing. What we have found each year is that premium contribution requirements are higher and benefits are less rich in the group with a mostly female workforce. 

Once again, our analysis of the 2023 data found that average in-network PPO deductibles (a measure of benefit richness) are higher in organizations with mostly female employees. We did see some improvement in the contribution required for employee-only coverage – where in our past analyses it had always been higher than in mostly male organizations, in 2023 it was actually $5 lower. However, the average contribution for family coverage remains significantly higher in the mostly female organizations. While it’s encouraging to see some narrowing of the gap, we need to keep in mind that females disproportionally work in low-wage industries, and thus are more likely to struggle with health care affordability than working males (in this analysis, for example, the average salary in 2022 was more than $15,000 lower in the mostly female companies relative to the mostly male companies). Lower pay, in combination with less generous health benefits, contributes to disparity in healthcare affordability. 

Within an individual organization, male and female employees are offered the same health benefits, so even if benefits are less rich relative to other industries, gender equity isn’t an issue – or is it? Other studies, such a recent report from Deloitte, suggest that another reason women spend more on healthcare than men is because they use more healthcare, even when services related to pregnancy and childbirth are not considered. 

Identifying a potential lack of equity is an essential starting point, but then what? While there is no one-size-fits-all approach to improving equity, here are some fundamental steps that would apply in many initiatives:  

Identify constraints 

Constraints usually relate to an employer’s budgetary limitations, though it can also include internal HR’s capacity for various undertakings.  

Collect, organize, and analyze available data

To identify disparities within populations some useful data sources include: 

• Employer survey data to understand differences in health benefits across industries, such as overall benefit richness or employer contributions. 
• Employee surveys, to illuminate the benefits which employees most value. 

Multiple years of claim information, by group (race/ethnicity, gender, sexual orientation), to identify differences in each group’s access to care, utilization of care, out-of-pocket cost, and health outcomes.  

Put data into action

At this point, changes from the status quo can be considered. Such changes may include offering lower-cost medical plan options; adding or changing vendors/programs that address a specific population’s needs; and making it easier for members to access care by adding virtual care options, assisting with transportation, addressing any language barriers in customer support and provider networks. Further in the process, communication is essential for employees to effectively utilize the plan. This is true whether changes relate to cost sharing, covered services, or support programs. Considering whether annual enrollment should be passive or active is also important, and each approach has pros and cons. 

Monitor results

Periodic benchmarking to assess actual results relative to expectations will help ensure that progress towards closing equity gaps continues over time. A high-value data warehouse can serve as the engine of equity initiatives, making it possible to separately track and analyze healthcare utilization, spending, and outcomes for identified groups. It can also help to independently assess the costs and benefits of new programs.   

Achieving health equity is a challenge, but not an impossible dream. Employers are discovering that with determination, data, and a plan, progress is not only possible -- it’s happening now.    

About the analysis

Emily Ferreira used data from Mercer’s National Survey of Employer-Sponsored Health Plans 2023 to complete the analysis described above. The analysis was limited to employers with 500 or more employees. There were 217 employers in the group with predominantly female workforces and 497 in the group with predominantly male workforces.