Background: “Why are the laundry bags in the men’s showers always fuller and need emptying more often than the bags in the women’s showers?” This question was raised at a meeting at the Department of Dermatology at Danderyd Hospital in Stockholm. The “Laundry bag” analysis was initiated in 2003 to answer this question and was performed as a cost comparative study in order to examine the extent to which the budget of the Department of Dermatology at Danderyd Hospital and its services, serve both female and male patient. Main diagnosis studied in this case are eczema and psoriasis. These were selected because they can be treated in different ways, and the aim of the study was to find out if there are specific gender differences in how women and men were treated.
When the patient first visits the Department of Dermatology, the doctor makes an assessment and prescribes a course of treatment, e.g. a series of UV treatment at the hospital, normally for 2-3 times a week for 6-8 weeks or and some form of topical treatment and moisturisers.
Questions guiding the analyses: Do men and women with dermatological diseases in need of UV treatment receive equal care? Is the financial resources used in accordance with both female and male patient’s needs?
Findings: The finding were surprising: Men with eczema or psoriasis received more help with emollients that women did and were given greater number of UV treatments. Women were to a larger extent prescribed self-care then men. There were no diagnostically reasons for this, e.g. women and men’s needs were the same. In spite of this, the prescribed treatment given to women was not the same as given to men. Despite that the total number of female patients and male patients diagnosed with eczema/psoriasis were more or less equal.
The study found that female patients constitute only 37% of patient at clinic and 36% at the SPA. When calculating number of treatments per patient and comparing total treatments for women respectively men, an even larger discrepancy between women and men were found: Women receive in total only 34% of treatments at the centre and 36% at SPA. A reason for this was that women were prescribed self-care to a much higher degree than men. This resulted in that 59% of the clinic resources were used for men treatment and only 41% of treatment budget was used for women. In contrast to that, the number of female and male patients was almost the same as was the total cost per treatment. Only cost of whole body UV treatment showed a somewhat larger difference for women and men. Women’s and men’s diagnostically needs were also similar.
Table 1. Average cost for treatment of patients with psoriasis and eczema, 2003 in Swedish krona (SEK) per treatment
|Treatment||Women||Men||Average cost per treatment for men and women|
|UV treatment, hands||5845||5790||5816|
|UV treatment, whole body||5200||6089||5758|
|Total budget||579 634||825 623||4948|
The study illustrates a case of engendered difference in resource allocation between women and men, where nobody would have thought to find some differences. It is visible in effects on budget, efficiency in budget utilization and in terms of effects at individual level.
Effects on budgets:
If women were given the same number of treatment as men the clinic cost would have increased with 61%. During 2003 women received “too little” treatment compared with men taking the diagnoses into account, i.e. 25% of the total treatment budget. Assuming women administer more self-care in the home than men, one can say that women are subsidising 25% of the publicly financed treatment. Finally, if the number of treatments given to women is taken as standard, the treatment budget would have been 22% lower. A conclusion is that differences in treatment of female and male patients, not based on diagnosis, rather influenced by other factors, have budget implications.
Efficiency is commonly defined as “providing public services, which offer value for money and are tailored to the needs of different communities”. The analysis shows that the service is not tailored to the needs of both women and men, hence the financial resources are not efficiently used.
Effects for female and male patients:
An effect on the gender differentiated treatment is that female patients pay more for treatment out of their own pocket. Women have to buy skin moisturisers at the pharmacy. This implies larger costs for them because in Sweden medication is subsidised to a lower degree than clinic treatment.
Since clinic treatment take place during day time it means that majority of men leave their work place to go to treatment during day time, while the majority of women are treating themselves at home after work, which also impacts the national economy.
Implications on a larger scale: reproducing gender norms and visibility
The study leads to a discussion on whether the gender norms existing today (Sweden), reinforce the importance of women keeping the skin clean, soft and smooth from very early stage. This message is conveyed to women through society examples, mass media and advertising. The society’s ideas of maleness, to which boys and men are expected to conform, do not contain the requirements for self skin-care to anywhere the same extent as for girls and women. Although the change is in the air, it is reasonable that these gender constructions are being perpetuated more or less consciously by hospital personnel and patients and are causing the gender imbalances in treatment analysed.
The findings show that public resources go towards financing men’s treatment of skin diseases to a far greater extent than they go towards financing women’s treatment of same diseases. Instead women treat themselves in the home to greater extent than men without the support of public resource. This self- care is also invisible in economic terms since it is not covered in the Swedish National Accounts and Sweden’s GDP calculations. On the other hand, men’s treatment is considerable more visible since it is administered at public institutions using public salaried employees and is reflected both in healthcare budget and in Sweden’s’ GDP calculations.