Two recent studies document that women may receive medical care inferior to the care delivered to men.
The first, published in JAMA Surgery, reviewed medical claims for over 860,000 Medicare beneficiaries who had one of four high-risk cardiac and vascular surgeries from 2015–20. They found that female patients were statistically significantly more likely to have serious complications or die, and to have “failure to rescue,” where their symptoms weren’t recognized and acted upon quickly. Male patients were more likely to have a re-operation, which in many cases could have been lifesaving. The researchers risk-adjusted the results for a wide range of factors, including the size and staffing of the treating hospital. They suggest that implicit bias may play a role and suggest better provider education. They also point to the need to report on results based on gender to identify such disparities.
The second study, published in Proceedings of the National Academy of Science, showed that women received later and less treatment for pain in emergency departments in the U.S. and Israel. This research was published in August and was recently featured in the Washington Post. Researchers reviewed clinical records of 21,851 patients seen in emergency departments in the U.S. and Israel and found that women’s pain was less likely to be documented, and when documented was less likely to be treated with pain medication. Women, on average, spent 30 additional minutes in the emergency department. Female, as well as male, treating doctors gave female patients less pain medication than they gave men with the same pain scores. Researchers also performed a small study that showed nurses rated pain lower in written case studies if the patient was identified as female.
A new Harris Poll of over 4,300 adults finds that 61% of Americans know someone who’s thought about, attempted, or died by suicide. A quarter of respondents said that they had thought about suicide, and 10% said that they had attempted suicide. Suicide takes over 48,000 lives per year, and is the 11th leading cause of death in the U.S.
The national suicide and crisis hotline (9-8-8), is now two years old, and has taken calls from 10 million people. This hotline is adding geolocation, and most callers report that it was helpful. One-third (33%) of survey respondents said they were familiar with 988, and 63% said they had heard of it. Seventy-one percent said they would feel comfortable calling a mental health hotline.
Almost one-third of respondents (31%) said that seeing a mental health professional was “something that most people could not afford” (down from 36% in 2018). A quarter of respondents (25%) reported that a barrier to them reaching out to crisis services was fear of out-of-pocket costs.
With so much interest in GLP-1 medications for obesity, it’s easy to overlook the important role bariatric surgery continues to play in treating obesity. Bariatric surgery is highly effective. People who have gastric sleeve or traditional bypass (Roux en Y) usually lose 70–80% of their extra weight in a year and maintain a substantial portion of that weight loss over the long term. The cost of bariatric surgery, about $25,000, is substantially less than the cost of ongoing treatment with GLP-1 medications.
Bariatric surgery is associated with improved metabolic function, decreased cardiovascular disease, decreased obesity-related cancers and improved life expectancy.
However, less than 1% of those who are eligible for this surgery have had it. While bariatric surgery performed at centers with multidisciplinary teams has a low rate of complications, those who have the surgery need to commit to altering their eating patterns. Many with obesity live far away from high-volume bariatric surgery centers, and many insurance plans have historically excluded bariatric surgery.
The WTW 2025 Best Practices in Healthcare Survey shows that 67% of employers (and 73% of employers with over 1,000 employees) now cover bariatric surgery. Those that don’t cover bariatric surgery often have plans designed years ago, when obesity was considered a lifestyle disease rather than a metabolic illness.
For employers reviewing their coverage of bariatric surgery, here are some considerations. These are based on the 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) guidelines.
The Peterson Institute for Health Technology, which published summary articles on diabetes and musculoskeletal digital health programs, earlier this year, published the results of its first survey of purchasers of digital health technologies. They surveyed 332 purchasers from 115 health plans, 117 employers and 100 health care delivery organizations. Digital health solutions range from an FDA-approved mobile app to address opioid use disorder to a comprehensive point solution to manage a chronic disease.
The Peterson Institute found that 75% of people who answered said they spent more money on digital health technology than two years ago. Most people say they will spend more money in the next two years. Respondents cited more consumer demand and better effectiveness of digital health solutions. Almost half (47%) of those that reported increased spending said that digital health technology decreased costs. More than half of respondents (53%) had between one and five digital solutions.
More than half of employers reported purchasing digital health technology for diabetes (78%), cardiovascular disease (54%), obesity (63%), mental health (57%), primary care (56%) and asthma or other respiratory diseases (55%). Employers reported that their evaluations of digital health interventions included improved health outcomes (99%), decreased health care costs (93%) and providing data back to community providers (97%). Health plans (63%) and employers (59%) often used direct contracting. The next most common way pharmacy benefit manager contracting (30%; health plan, 32%; employer). Employers were more likely to rely on formularies for digital health access (65% employer, 58%; health plan).
Eighty-nine percent of employers reported that their contracts included risk-based terms to ensure contract performance. Most contracts were for two years or less.
Jeff is an internal medicine physician and has led WTW’s clinical response to COVID-19 and other health-related topics. He has served in leadership roles in provider organizations and a health plan and is an Assistant Professor at Harvard Chan School of Public Health.
Plan redesign outweighs cost-shifting to reduce the cost of care, WTW survey finds
