Gender Disparities in Health-care Expenditure (HCE) and Financing Strategies (HCFS) for In-patient Care in India

Moradhvaj & Saikia, N. ORCID: https://orcid.org/0000-0001-6735-6157 (2019). Gender Disparities in Health-care Expenditure (HCE) and Financing Strategies (HCFS) for In-patient Care in India. SSM - Population Health 9 e100372. 10.1016/j.ssmph.2019.100372.

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Abstract

Background

Despite the presence of a vast literature on health-care expenditure (HCE) and health-care financing strategies (HCFS) in low- and middle income countries, there is limited evidence of gender disparity in HCFS for in-patient care.
Objective

We examined gender disparities in HCE and HCFS for in-patient care among adults aged 15 and above in India, a South Asian population giant, widely known for gender-based discrimination in sex-selective abortion, nutrition and access to healthcare.
Data and Methods

Using data from a nationally representative large-scale population-based survey, we investigated the relationship between the gender of adult patients and HCE as well as sources of health-care financing. Simple percentage distribution, cross-tabulation, two level random intercempt model and multinomial logit regression were carried out to examine the role of gender in HCE and sources of health-care financing for in-patient care.
Results

Average HCE is lower for females in adult age groups, irrespective of type of diseases and duration of stay in the hospital. This result remained unchanged after controlling other background variables of the patients. Females are also discriminated against more when health care has to be paid for by borrowing, sale of assets, or contributions from friends and relatives (distressed financing). Multinomial logit results show that the probability of distressed financing is less for females than for males (Borrowing: β=-0.27; CI:-0.37--0.17; p=0.001; selling assets/contribution from friends and relatives (β=-0.27; CI: -0.39--0.14; p=0.001). The predicted probability of using health-care finance implies that the health of adult men is considered to be more important in terms of resorting to distressed financing than that of their female counterparts.
Conclusion

HCE on adult women inpatients is systematically lower than that of adult men inpatients. Further, women in India have less access to in-patient care through distressed HCFS.

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