Health Policy

Understanding Women's Use of Out-of-Network Health Care Services and Implications for Health Care Reform

Susan Busch, PhD

Susan Busch, Ph.D., Associate Professor, Division of Health Policy and Administration

Co-funded by the Maximilian E. & Marion O. Hoffman Foundation Inc. and the Robert Wood Johnson Foundation Clinical Scholars Program.

Women pay higher out-of-pocket costs for health care than men. One hypothesis for this disparity is that women disproportionately use out-of-network health care services, which are much more expensive than in-network services. Some women deliberately choose to use out-of-network health care providers. However, recent mainstream media reports have highlighted consumer frustration over unexpected charges from out-of-network providers who are affiliated with hospitals/emergency rooms which are in network. Women, in particular, often absorb much of these out-of-network charges as higher out-of-pocket copayments when insurers pass these costs on to consumers.

Highlighted Study Findings

In this ongoing study, Dr. Busch is conducting and using a nationally representative survey of privately insured adults, aged 18 to 64, to analyze this reported disproportionate use by women of out-of-network health care services. There are no high-quality unbiased data about this issue for women, so the study results are likely to inform policy makers as out-of-network health care reform moves forward. Dr. Busch has completed the survey and the results are about to be published.

The Effectiveness of Breast Ultrasound Screening

Regina Hooley, MD

Regina Hooley, M.D., Assistant Professor of Diagnostic Radiology

Mammography screening can reduce breast cancer mortality through early detection, but has limited ability to detect cancers in women with dense breast tissue. Because of this limitation, other screening methods, including breast ultrasound, have also been used to detect breast cancer. 

In this study, Dr. Hooley will investigate the performance of breast ultrasound since the 2009 implementation of a Connecticut law which mandated that radiologists inform women with dense breast tissue that they may benefit from supplemental screening with ultrasound, after mammography. 

Through her review and analysis, Dr. Hooley and colleagues can determine the usefulness of ultrasound plus mammography in detecting tumors not revealed by mammography alone.