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. 

Elderly Drivers

Richard A. Marottoli

Dr. Marottoli will seek to identify the cognitive, health, and environmental factors in elderly women that predict adverse driving events such as crashes and tickets, leading the way toward interventions that can enhance their safety and public safety.

When Dr. Richard Marottoli sees elderly patients, he often struggles to determine when they are no longer able to drive safely.

Now as one of four new studies funded through WHRY’s Pilot Project Program, Marottoli aims to identify the cognitive, health and environmental factors that can predict adverse events among women drivers, such as crashes and tickets. His goal is to develop interventions that can make his patients and the public safer.

“I think it will give us a chance to make a vast improvement over our current capability to assess safe driving capability,” Marottoli said.

By 2030, one-fifth of all drivers will be at least 65 years old. Currently, 73 percent of women over 65 still drive. Between 1990 and 2020, the distances traveled by older female drivers will increase by 500 percent.

“Older women are more likely to live alone and feel compelled to keep driving,” Mazure said. “Moreover, women suffer more from osteoporosis, leaving them more at risk of a serious or fatal injury from a crash. Dr. Marottoli’s study will help shed light on this growing issue and lead the way toward solutions.”

Because women, on average, live longer than men, the study addresses an urgent need to provide guidance in determining when women should stop driving.

“It’s a big deal for people,” Marottoli said. “In the vast majority of our country, if you don’t drive, you can’t leave home. It’s synonymous with freedom and independence.”

About the Investigator

Dr. Richard A. Marottoli earned his M.D. from the Yale University School of Medicine, his M.P.H. from the Yale University School of Public Health, and his B.A. from Yale College. He has been a professor of medicine at the Yale School of Medicine since 2013 and has served as Medical Director of the Adler Geriatric Assessment Center at Yale-New Haven Hospital since 2006.

His primary research interests include enhancing clinicians’ ability to identify individuals at risk for driving difficulty, developing interventions to enhance drivers’ safety, and identifying ways to ease the transition to driving cessation when necessary.