Moradhvaj, Moradhvaj (2017). 'Gender Disparity in Intra-Household Health Care Expenditure: Empirical Evidence from India' Paper presented at the annual conference of the HDCA, Cape Town 2017.



Gender disparity in health care and morbidity in India has been well documented in recent decades. The female advantage in life expectancy at birth is a recent phenomenon in India, unlike in many parts of the world. Also, the female advantage in overall life expectancy at birth masks the disadvantage spread across ages: In India, females are still subject to feticide and excess mortality.Several research has shown that there is a significant variation in the health status of population and utilization of health care services. The literature on the social determinants of health showed how social and cultural factors affect health and longevity. One such factor is gender-based discrimination in health care utilization and lower health investment results of worsts health status of women and higher mortality compared to men.

In a patriarchal society where female face discriminatory behavior in term of health care, nutrition intake, education and other opportunity,  In India context are especially important to study the effect of gender on health.  However, in India, the effect of gender on treatment seeking behavior within the household are relatively got less attention. Therefore, the aim of this study to examines a) the gender disparity in average in Intra-household HCE for inpatient care in India. b) what are the demographic and socio-economic factors that affect in HCE, in general? c) is the gap in HCE due to the differential distribution of the socio-economic and characteristics or due to some unexplained reasons?

Data source

 This study used 25th schedule for two rounds (60th and 71st) of the National Sample Survey Organization (NSSO)


The descriptive statistics and bivariate analysis used to describe the characteristics of sample of the study (inpatients) and to estimate average HCE separately for male and female by background characteristics. To quantify the role of demographic, socio-economic and other disease-related variables in HCE, we used decomposition technique propounded by Oaxaca.  The core idea is to find out the inequality in HCE is the consequence of the distribution of a set of the difference in the socio-economic and demographic factors.

Preliminary findings

Result clearly indicate that gender disparity exist in HCE; the average HCE was reported higher for males than females in both round of survey. Gender disparity in average HCE increased four times in 2014 compared to 2004. Gender disparity in HCE allocation is more apparent in higher age groups than lower age group patients. Patients who used private health facility show higher disparity compared to public health service users.  For the treatment of Non-communicable disease shows higher disparity because of more expensive/higher cost of treatment compared to communicable disease. The region-wise analysis of HCE shows that in Northeast, females show better position compared to North, Western, and Central region of India.

Decomposition Results:

Oaxaca decomposition result suggests that about 85% male-female difference in HCE is explained by the difference in the distribution of socio-economic and demographic factors. Type of education, type of disease, level of care and hospital duration is contributing towards widening the gender gap in HCE. The contribution of the duration of hospitalization towards widening gap was the highest (about 35 %): it explain that the distribution of duration of stay in hospital is more favorable to males than female. Next was the type of disease (27%), education (26%), Level of care (12%).  About 18% of the difference was explained by the effect of determinants (coefficient). The positive contribution by age group, sector, education etc. indicates that effects of these factors are responsible for wider gender gap in HCE.

Discussion and conclusion

Gender disparity in HEC is a critical challenge to improve the women health status in India. This study made a comprehensive effort to document Change and the Factors Explaining the Gender Differences in Health Care Expenditure in India. Our findings reveal that in spite of considerable progress in socio-economic and demographic transition in India, the Gender differences in health spending increased in the latest period, 2014 compared to an earlier period, 2004. Gender disparity in HCE is varied among the all-India states.  Northern states such as Punjab Haryana, Uttar Pradesh and Bihar shows higher gender disparity whereas northeast states and some central states such as Assam, Chhattisgarh, Jharkhand, Manipur Meghalaya, Mizoram and Uttaranchal shows less disparity between male-female HCE for hospitalization.

Results suggest that about 84% gender difference in HCE is due to male-female difference in socio-economic, demographic and healthcare-related factors. Type of education, type of disease, level of care and duration of stay in hospital are contributing towards widening the male-female gap in HCE. And 18 % difference in male-female HCE is due to the effect of these factors on HCE. Thus the contribution by coefficient represents the genuine role of gender in OOP expenditure, i.e., less is spent on female health because of the notion that female health is not as important as male health.

Overall, the findings suggest that increase in the education of the women is the main factor explaining the Gender difference in health care spending. Thus, removing intra-group inequalities in the educational status of women is a must to eliminate Gender differences in healthcare spending because “within women inequalities” contributed in bulk to overall Gender differences in health spending. To reduce the gap between male-female OOP expenditure, we need to economically empower the women through improving education status and changes in gender attitude. Out of pocket HCE in India higher in the world, around 71 % expenditure is out of pocket made by household.  There is a need to reduce the gap between male-female OOP expenditure through improving the quality of care and providing subsidies in public hospitals to targeting gender discriminatory behavior against women. Therefore, the Policies and Programme aiming to eliminate Gender Differences in health spending must focus on women in deprived social and economic groups and improve their education and increase public health care facilities for treating their illness or ailments.


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