Is Medicare Clearing Better Pathways to Wellness for Men With Depression?

You would expect Medicare to spend about the same for a man with heart, lung, or kidney disease as it does for a woman.  And if you looked at the actual numbers, you would not be surprised.  On average, it does. 

So why does Medicare spend so much more on men when you couple these disease with depression? That is a question that deserves an answer.

The startling numbers, which show just how wide the disparity is, are in the chart accompanying this column.  They are very similar to some others that I shared in my column last week.

They all come from the 2010 CMS Medicare public use data files, the most recent ones available.  The CMS file includes information on all 48 million Medicare recipients. 

Last week, I wrote that men with depression in the 65-69 year old age group enjoyed an 11% Medicare spending advantage over women in the same age group.  (The men were those on Medicare only, not both Medicare and Medicaid.)  I also wrote that the disparity persisted both as they aged and when they were diagnosed as having both depression and dementia.

That column raised at least one troubling question – why are women with depression being undertreated relative to men, when they are two to three times more likely to be diagnosed with it?

I received a number of possible answers to that question, but the most common one was that perhaps men’s needs are more intensive.  Because they are diagnosed less frequently, they may simply be sicker by the time they are, and therefore need more treatment.

The Medicare data do not include a severity measure, so there is no way to tell for sure.  But there is at least some indirect empirical evidence for this. The Medicare spending gap in favor of men is wider for hospital care (Part A) than it is for outpatient treatment of drugs (Parts B/D).

If there were an intensity advantage, however, it should disappear as people get sicker.

But it doesn’t. If anything, it may get a little wider. 

This week, I looked at some groups with greater health needs – Medicare recipients in the 65-69 year old age group who were dually diagnosed with depression plus heart disease, depression plus lung disease, depression plus kidney disease, or depression plus cancer.  In every case, being sicker (i.e., having a second diagnosis of depression on top of the other chronic disease) led to a wider gap in spending.

Three of the examples are captured in the chart.  As expected, there’s very little gender bias in Medicare spending on heart disease (2% more on men), lung disease (1% more on men), or kidney disease (4% more on men).  There is a gender bias in spending on cancer, but it favors women (Medicare pays 26% less on men with cancer).

When you add depression to these conditions, the spending tilts in favor of men again.  

• The 2 percent difference in spending favoring men with heart disease grew to 9 percent when the men and the women had both heart disease and depression. 
• The 1 percent difference in spending on lung disease expanded to 13 percent when both lung disease and depression were present. 
• And the 4 percent difference in spending favoring men with kidney disease ballooned to 30 percent when both kidney disease and depression were present.

And the cancer spending gap dropped from 26 percent down to just 15 percent.

The difference is clearly the depression.

Medicare simply spends less on women with depression, even when they have other serious chronic conditions.  You can decide for yourself about the reason.  Are men underdiagnosed? Are women overdiagnosed?  Are men overtreated? Are women undertreated?

The CMS data set does not answer those questions.

But it does tell us this – Medicare-eligible men and women with depression, at least in this age group, are clearly being treated differently.  For whatever reason, the men are getting more, and the women are getting less.

Today is the start of Mental Health Month.  This year’s theme is “Pathways to Wellness.”  So here’s my question, similar to last week’s.   Is Medicare clearing better pathways to wellness for men with depression than it is for women?

To reach Paul Gionfriddo via email: gionfriddopaul@gmail.com.  Twitter: @pgionfriddo.  Facebook: www.facebook.com/paul.gionfriddo.  LinkedIn:  www.linkedin.com/in/paulgionfriddo/