Gender and access to medicines through the national health services

Abstract

Gender and access to medicines through the National health services It is only recently that the issue of gender differences have prompted scrutiny and generated interest within the medical field. In the past few decades, gender differences in activities, goals and longevity were taken for granted, being quite predictable, however today this situation has changed, making gender differences more open to change (Verbrugge, 1985). The overall aim of the study is to identify whether there is a gender bias in terms of access to NHS medicines in Malta, as per diseases listed under the Fifth Schedule of the Social Security Act (Schedule V). This study aimed at determining whether selected diseases listed on Schedule V are more prevalent in males or in females. Specific literature searches to enable gender sensitive assessment were conducted using Medline®, Pub med®, Google scholar® and specific journals. To establish gender bias in terms of access to drugs on Schedule V, the Maltese national formulary was retrieved, together with the relevant drug use protocols. All information gathered was transferred in Microsoft Excel® for further analysis. International consensus guidelines were retrieved from NICE and SIGN. When not available, other international consensus guidelines were consulted including the BNF 58. To investigate the possibility of gender bias in access to drugs through omission of diseases as approved by Schedule V, a section of gender specific drug treatable diseases from the ICD-10 was analyzed. The results obtained clearly demonstrate higher gender prevalence in certain diseases (e.g. angina, chronic rheumatoid arthritis and systemic sclerosis are more prevalent in females; while congestive heart failure, Parkinson's disease, schizophrenia and hepatic cirrhosis are more prevalent in males) and no gender revalence in others (e.g. myocardial infarction and peptic ulcer disease). The available literature does not always indicate the gender predominance. In some instances this is not reported at all. Gender sensitive literature for Crohn's disease, diabetes insipidus and Huntington's chorea is not available, while there is no clear evidence to the gender prevalence for ulcerative colitis, chronic renal failure and psoriasis. For the intent of this study, various international consensus guidelines including SIGN, NICE and the BNF 58 were referred to and compared to the local formulary and the pertinent protocols to evaluate what is available and approved for use by protocol on Malta's national formulary with respect to the diseases listed on Schedule V. No gender bias in terms of access of medications for conditions listed on Schedule V was found. Following the analysis of gender specific drug treatable conditions for ICD-10 resulted in a list of conditions which are omitted from Schedule V, possibly creating a bias in terms of access of drugs for these conditions. The analysis leads to the conjecture that most of the medications listed on the national formulary are available and approved for use in diseases approved, as recommended by the international consensus guidelines taken as a reference. Consequently one can conclude that there seems to be no gender bias in terms of access to medications for the diseases approved by the Schedule V. The specific gender-related drug-treatable conditions of the genito-urinary system namely male disorders of the genital organs, inflammatory diseases of the prostate and male infertility, and female related disorders namely menopause, pelvic Inflammatory disease, disorders of menstruation and female infertility are not conditions which entitle patients to free medications through NHS.

Mental health and musculoskeletal disorders (osteoporosis) are conditions with a female prevalence. This study deduced that these conditions are omitted from Malta's official disease list for which entitlement to free medications is approved. Looking at the percentage of employed women in relation to the positions occupied and wages earned, one reaches the conclusion that a high percentage of the Maltese female population is financially dependent. To add to this, another important consideration to be made is the fact that females tend to outlive males, and that most often they rely on males for economic resources, this means that a large percentage of older women are at risk of dependency, isolation and poverty (WHO, 2003). In light of these facts, together with the findings of this present study, it is plausible to conclude that the fact that the above mentioned gender-related drug treatable conditions which are omitted for the list of diseases, for which free medications are approved puts a large proportion of the Maltese female population at risk. Most of the medications needed to manage or treat the female related conditions mentioned earlier are already available for use through NHS; however these are not approved for the conditions investigated in this analysis. This clearly indicates a bias in terms of access for the female patient suffering from any of the mentioned condition.