Gender disparities in health care expenditures and financing strategies (HCFS) for inpatient care in India

Despite the vast literature on health care expenditures (HCE) and health care financing strategies (HCFS) in low- and middle-income countries, there is limited evidence of gender disparity in HCFS for inpatient care. We examined gender disparities in HCE and HCFS for inpatient care among adults aged 15 and older in India which is widely known for gender-based discrimination in sex-selective abortion, nutrition, and access to health care. 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, a two-level random intercept model, and multinomial logit regression were used to examine the role of gender in HCE and sources of health care financing for inpatient care. Average HCE is lower for women in adult age groups, regardless of the type of disease and duration of stay in the hospital. This result remained unchanged after controlling for other background variables of the patients. Women 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: beta = 0.27; confidence interval [CI], 0.37 to 0.17; P = .001; selling assets/contribution from friends and relatives: beta = 0.27; CI, 0.39 to 0.14; P = .001). The predicted probability of using health care financing implies that the health of adult men is considered to be more important, in terms of resorting to distressed financing, than that of adult women HCE on adult women inpatients is systematically lower than that of adult men inpatients. Further, women in India have less access to inpatient care through distressed HCFS.