Great Indian handicap: Men with disabilities spend more on healthcare than women

Study by Indian researchers demands the immediate attention of policy-makers, government and other stakeholders to address the disparity.

ByChetana Belagere

Published May 19, 2024 | 7:00 AMUpdatedMay 19, 2024 | 7:00 AM

Out of pocket expenditure on health is more for women than men, finds study from India.

Indian men with disabilities spend more than their female counterparts on healthcare, a recent study published in the Journal of Health Management has revealed.

The study, ‘Gender Inequality in Out-of-Pocket Expenditure on Healthcare Among Persons with Disabilities in India’, shed light on the stark gender inequalities in healthcare costs among Persons with Disabilities (PwDs) in the country.

The findings raised the question if Indian women with disabilities have been receiving adequate healthcare.

Researchers used data from the National Sample Survey’s 76th round, which painted a concerning picture of out-of-pocket expenditure (OOPE) on healthcare across different states.

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Burden of healthcare

According to the findings, the financial burden of healthcare is disproportionately higher for males in most regions, except in a few areas, where females spend more.

“There is a significant gender disparity in healthcare spending among households with disabled members in India,” the study stated.

“Based on data from the National Sample Survey’s (NSS) 76th round on ‘Persons with Disabilities in India’ (July–December 2018), which shows that high out-of-pocket expenditure (OOPE) on disability-related healthcare disproportionately affects males compared to females,” it pointed out.

The unexpected trend raised questions about the accessibility and utilisation of healthcare services by disabled women.

It was found that in all states, except Union Territories Puducherry, Dadra and Nagar Haveli, Lakshadweep, and Mizoram, males reported a higher percentage of their monthly per capita expenditure going towards healthcare costs — from as low as 0.6 percent in Jammu and Kashmir to 20 percent in Nagaland.

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The poverty factor

Prof Denny John, faculty at the MS Ramaiah University of Applied Sciences and co-author of the study, detailed the findings to South First.

“We found that nationally, 20% of household consumption expenditure is dedicated to healthcare for disabled family members, with males shouldering a higher OOPE burden (23%) compared to females (17.2%),” he said.

The study said it used data that covered 8,992 village/urban blocks that included 1,18,152 households.

Researchers looked at 1,06,894 people — 61,567 men and 45,305 women — who reported any type of disability at the time of the survey.

The disabilities included locomotor, visual, hearing, speech and language, mental retardation/intellectual disability, mental illness, and others.

“People with disabilities unduly suffer greater ill-health compared to the non-disabled population, mainly due to poverty. High healthcare expenditure on disability may impact overall household consumption expenditure,” Prof John said.

He explained that “High OOPE may act as a barrier to healthcare services and further resulting in inadequate economic safety and healthcare inequities”.

The multilevel analysis confirmed that females generally incurred significantly lower OOPE compared to males, even after adjusting for demographic and disability-related predictors.

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Why women spend less?

Prof John felt that women, particularly those with disabilities, might have less access to healthcare services. Cultural and societal norms could sometimes restrict women’s mobility or their ability to seek healthcare independently.

Meanwhile, economic factors such as women often having lower economic status or less control over financial resources in many societies could limit their ability to afford healthcare costs.

Also, some households, especially in lower-income or traditional settings, could have given priority to the health of their male members, leading to more healthcare spending on men than women.

Further, lower levels of education and awareness about diseases and available healthcare services might have led to the under-utilisation of healthcare services among women with disabilities.

The fear of discrimination or negative treatment at healthcare facilities and the lack of female healthcare providers and gender-sensitive care might have also prevented women from accessing healthcare.

Also, women might underreport their health issues or suffer health problems without seeking medical attention due to societal expectations of them to endure hardships.

“Understanding and addressing these factors is crucial for improving healthcare access and equity for women with disabilities,” Prof John added.

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Importance of the study 

Prof John highlighted the implications of the findings, stating, “Our study reveals significant gender disparities in the financial burden of healthcare among disabled individuals. This underlines an urgent need for gender-sensitive policy-making to address these inequities.”

The study further discussed the impact of such financial burdens on the quality of life and access to necessary services for PwDs, emphasising that higher expenditure did not necessarily translate to better or more frequent healthcare usage, particularly for women.

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The Karnataka scenario

Prof John explained that the study found that in Karnataka, 18.6 percent of household’s consumption expenditure was spent on healthcare expenditure on disability. It was the lowest compared to other southern states, viz., Kerala, Andhra Pradesh, Telangana, and Tamil Nadu.

In terms of the gender gap, the OOPE difference in Karnataka was ₹1,050. It showed that women spend more on medical care.

The highest gaps in male-female differences in mean OOPE were observed in Andaman and Nicobar Islands (₹3,463), followed by Nagaland (₹2,543), Uttarakhand (₹1,846), Manipur (₹1,332), Haryana (₹1,156), Daman and Diu (₹1,149) and Maharashtra (₹1,071).

Some Union Territories and states like Puducherry (₹–3,696), followed by Dadra and Nagar Haveli (₹–536), Lakshadweep (₹–248) and Goa (₹–124) had lesser gaps in spending.

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What does it suggest?

The study suggested that OOPE and its burden on healthcare in Karnataka households have gender inequalities among PwDs. It would require long-term social, cultural, and policy changes.

However, since the NSS round did not capture the expenditure among non-PwDs, comparisons could not be made.

“Ensuring healthy life and promoting the well-being of people belonging to all ages (goal 3) and achieving gender equality and empowering all women and girls (goal 5) are two of the sustainable development goals (SDGs) in the UN’s agenda,” Prof John said.

To achieve these goals, the key would be to recognise the disadvantaged and the omitted using a gender lens, especially among PwDs.

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Recommendations

“Our study identifies the general differentials in OOPE and OOPE burden on healthcare among PwDs in India and highlights the need for gender-sensitive programmes and policies targeted at PwDs by the Government of India,” Prof John said.

The findings made an urgent call to health researchers and policymakers to consider the disparities while formulating healthcare policies.

“There is a critical need for policies that specifically target the reduction of financial barriers for all genders, but particularly for women, to access healthcare services,” the authors said in the study.

The authors add that there was a need to ensure that women benefitted from the various PwD-focussed government programmes.

Researchers Jeetendra Yadav, Denny John, Geetha R Menon, and Ravinder Singh from the Department of Health Research at ICMR National Institute of Medical Statistics, Department of Public Health, Amrita Institute of Medical Sciences in Kerala and MS Ramaiah University of Applied Sciences, Bengaluru, conducted the study.

(Edited by Majnu Babu).