Healthcare Financing: Women Discriminated Against In Indian Households

Gender-based discrimination in the South Asian region with respect to breastfeeding, food allocation, immunization and access to health-care services has been extensively discussed in empirical studies. India, widely known for distorted child sex ratio and excess female deaths at a younger age, has some good news in most recent rounds of NFHS. For example, in most recent years, India experienced a rapid decline in excess female deaths under age 5 or gender gap in immunization reduced drastically in years. 

However, the gender gap in access to health care or health care expenditure has not been minimized in recent years. Almost 71 per cent of healthcare expenditure (HCE) in India is out of pocket healthcare OOPE (out of pocket expenditure) incurred by households. Usually, OOPE leads impoverish due to catastrophic health financing for healthcare. The distribution of HCE depends on the household members involved in decision making for seeking treatments and is dependent on a number of factors including the perceived cost of illness, perceived severity of illness, etc. What does an Indian household do in such a situation?  

We did research on healthcare financing strategies in India and found that Indians are spending lesser on females inpatient care irrespective of the type of diseases and duration of stay in the hospital. This is despite the fact that women suffer from a higher incidence and prevalence of morbidity. Analysis of large scale data shows that female in-patient healthcare expenditure is much lower than that of men even after controlling the demographic and socio-economic characteristics of the patient. It’s indicating the presence of a strong preference for the health of male adults rather than the health of female adults. 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).  

There may be two reasons why females in India are facing discrimination in accessing distressed healthcare financing. First, as 60 per cent of rural households in India use distressing means of health-care financing to avail themselves of in-patient care, households may make a trade-off between a breadwinner and a caregiver. Only 27 per cent of Indian women are engaged in paid jobs, and the rest are involved in unpaid household chores and care-giving, that is, non-economic activities. Since household chores and care-giving do not yield direct economic benefits, the relative importance of women’s health is underestimated. Second, a discriminatory attitude toward the health of women in India has existed for generations due to social hierarchy and deep-rooted patriarchal structures.  

Decreasing the financial burden of catastrophic health expenditure problems, for example, in cases of hospitalization and in-patient care, can help decrease gender disparity in health-care utilization. To reduce the gender gap in health care access and expenditure, there is a need to introduce gender-inclusive social health security and micro-insurance schemes in India. However, a long term sustainable strategy to reduce gender-based discrimination in healthcare is to empower women economically and socially through education and economic activities.