Women's Health Clinic Brief
To the
Standing Senate Committee on Social Affairs, Science and Technology
November 2001
WHY WOMEN ARE CONCERNED ABOUT HEALTH CARE REFORM?
Women's Health Clinic* submits this brief as we strongly believe that health care reform is a women's issue. Women account for the majority of care recipients and of those who take care of others. Women provide more than 80% of the paid and unpaid health care in this country. This is especially the case among the elderly. In many ways examining the experiences of women with health care is illustrative of what is happening to all Canadians.
Women's use of the health care services is higher primarily because of our reproductive role. As with men, the burden of ill health is connected to income levels. This is of a significant concern to women as the poverty becomes increasingly "feminized". For example:
- Almost half, 49%, of all unattached (single, divorced, widowed, separated) Manitoba women over the age of 65 live in poverty.
- More than two thirds of poor Manitoba women work and are not on social assistance.
- Almost 70% of Aboriginal women in Manitoba live below the poverty line.
- Most poor women feed and take care of their children before they care for themselves.
- There are 40% more poor women in Manitoba than poor men.
- Most single parent families are headed by poor women.
- Without their spouses income 50% of married women in Manitoba would be poor.
- Poor women are found in all areas and among all groups of Manitobans.
- 25% of Manitoba kids grow up in poverty. Obviously a lot of long-term problems are ahead, unless specific, practical ways are found to help their mothers.
- Research shows that overall everyone in a community, rich and poor, is less healthy when there are big gaps between the people living in that community.
- Most poor women report that they feed and take care of their children before they care for themselves. 25% of Manitoba kids grow up in poverty.
Recent work by Denton and Walters, show that the connection between income and health is stronger for women than for men. Due to unequal labour force participation, such as part time work and low wages, women generally have lower lifetime earnings and accumulation of pension credits, thereby adding to women's risk of poverty and reducing access to extended medical insurance which covers drugs, dental services etc. As well poor women are less likely to access prevention and screening programs unless targeted client friendly models are used. Women's Health Clinic paper, Women, Poverty and Health in Manitoba explores these issues in more depth.
Women are profoundly interested in what consequences reforms have for women as patients and as caregivers, either paid or unpaid. It is important to acknowledge that there are significant differences among women related to their physical, social, economic, cultural/racial background, locations and their age and sexual orientation. These, too, must be considered in assessing the consequences of reforms.
"It appears that privatization has been the primary strategy in health care reform, and this was the case even before Alberta and now Ontario made this strategy a public issue.
Privatization of health care refers to several different policy directions, which limit the role of the public sector and define health care as a private responsibility or even a market commodity. Privatization in the health care system can occur in the payment for health care services or the provision of health care services. The multiple forms of privatization often confuse the pubic debate and we found it useful to sort out its various strands.
The privatization of health care includes:
- privatizing the costs of health care by shifting the burden of payment to individuals;
- privatizing the delivery of health services by expanding opportunities for private for-profit health service providers;
- privatizing the delivery of health care services by shifting care from public institutions to community-based organizations and private households;
- privatizing care-work from public sector health care workers to unpaid caregivers; and,
- privatizing management practices within the health system, by adopting the management strategies of private sector businesses, by applying market rules to health service delivery and by treating health care as a market good." ¹
All provinces have moved to shift health care costs to individuals, to shift care delivery to for-profit concerns, to shift managerial practices to for-profit approaches, to shift care responsibility to households and care work to unpaid caregivers.
Although there are similarities among provinces, there are also significant differences. The process is uneven across the country. Indeed, some provinces have reversed privatization in some areas while others explicitly rejected certain forms of privatization. In Ontario, for example, midwifery has become a public service and Manitoba has reverted to public home care services after experimenting with some for-profit delivery.
Research that does take women into account suggests many health care reforms are having a negative impact on women. Those doing paid health care work are facing increasing workloads and increasing stress. More women are being "conscripted" into unpaid health care work, without training and with few supports. Those sent home quicker and sicker are finding it more difficult to get care, and important questions need to be asked about the quality of care they are receiving not only at home but also in institutions.
A Quebec study, for example, found that women often "had to give their spouses more complex types of nursing care, such as changing dressings, irrigating wounds and administering and monitoring medications, hygiene and diet: 75% of these women were themselves receiving services from health care professionals every week...The main problem that these women reported were as follows: the lack of any choice about the way they handled the situation, having their own health become more fragile because of the burden they were carrying as caregivers; feeling insecure because they had to provide such complex care; the lack of planning surrounding the patient's discharge from hospital and the home care to be provided subsequently; and the transfer of costs from the health care system to the people receiving care" ²
The research on differences among women, although even harder to find, suggests that those who have traditionally been most vulnerable are facing deteriorating conditions for care. User fees, for example, can mean elderly women who are more likely than men to be poor, cannot get their prescriptions filled.
