Constrained Choice: Gender Bias and Quality of Routine Care for Cardiovascular Disease

Some medical decisions are so clinically accepted that they are structured into guidelines and used as measures of the quality of care delivered.  In the case of quality of routine aspects of care, the focus is on decisions where care has been shown to be cost effective in improving outcomes.  Quality of routine aspects of care for cardiovascular disease (CVD) is not merely the product of individual provider-patient encounters. The decision processes of clinicians and patients are shaped by assumptions about risks and benefits, as well as other costs including the expense, side effects, and convenience.  Here we consider how examining Constrained Choice can facilitate or impede efforts to improve quality of care.  In this framework responsibility for health is allocated between individual agency and various higher units of organization including, family, workplace, community, and social policy makers.  We examined gender and racial/ethnic gaps in routine aspects of care for cardiovascular disease in the United States. Data from a large US health insuror on quality of care for CVD and diabetes suggest that many (but not all) of the factors that enhance or impede health and healthcare often extend beyond the control of individuals. We discuss the nature of the disparities and approaches to addressing the gaps in care.