REVIEW ARTICLE: Does discrimination drive gender differences in health expenditure on adults: Evidence from cancer patients in rural India?

Does discrimination drive gender differences in health expenditure on adults: Evidence from cancer patients in rural India

Akansha Batra, Indrani Gupta, Abhiroop Mukhopadhyay

January 2014 Discussion Paper 14-03

 Abstract:

This paper focuses on and tries to investigate the role of gender discrimination in healthcare expenditure and treatment-seeking behavior in adults. The study had used a longitudinal survey in the rural settings of tertiary healthcare center of Odisha, India. Subjects that were undertaken were cancer patients and how much gender discrimination attributes to the difference in treatment expenditure. The research finds out after the detailed analysis that expenditure on females is significantly lesser than on males, and most of the difference is before coming to the tertiary center. Gender discrimination attributes to 73% of the difference in expenditure. This article will summarize and explain the use of study in various sectors of health.

Introduction:

Health inequities are the major huddle in the developing countries for the healthcare-seeking behavior and it is one of the precursor as well as the outcome of the poverty(1). One of the inequities is generated by the broader societal part of the gender-based discrimination which manifests in lower health investments as well as the poor health status of women compared to men. Denton et al contribute this differentiation in one of the social determinants of health.

The studies have been done on the child sex ratio and the mortality of girl child in comparison to a boy which also highlight the neglect of girls of 12 years of age in the nutritious diet as well as full immunization (2). Moreover, this pattern is seen in the various level of socio-economic households of society(3). In India, the patriarchal society is relevant in the discriminatory treatment of women in all stages of life and it is especially relevant in healthcare(4). Pandey et al’s study in the west Bengal throws light on discrimination in the treatment of diarrhea and also in rural settings delay in diagnosis of tuberculosis amongst females which results in poor health outcomes.

This paper is intended to study gender discrimination further in the context of Cancer in rural patients of Odisha, India. The choosing of the context of cancer is because it reduces the bias of perceptiveness of the seriousness of the disease. The discrimination is analyzed by using a longitudinal survey and the aim is to “understand the presence and magnitude of differences in health expenditure between males and females and the likely determinants of such differences in a multivariate framework.”

Data and methods:

A primary longitudinal survey of 204 cancer patients residing in rural Odisha, India. The survey was conducted at a public tertiary hospital in the city of Cuttack over 5 months in 2007. The information on expenditure included money spent on treatment as well as non- medical expenditure of traveling, food, and overnight stay after coming to the hospital. Also, similar information on medical and non-medical expenditure was recorded before coming to the hospital (before the onset of symptoms). Follow up survey was done after one year to record the expenditure last year.

From the 204 patients, 71% were women. The average age of the patients was 49 years. The sample covered the most common cancers of India and was divided into 1) Cancer-specific to women, 2) Cancer-specific to men, 3) Common cancers. And gender discrimination can only be measured in common cancer.

The patients who were part of the survey had a similar household situation economically as well demographically. The average education among patients is high. Around 25% of patients have at least secondary schooling and the male has a higher education than females. The average education of the decision-maker of the household is 7-8 years in both cases. The cancer treatment is not available at all the places and patients came from the faraway places the average distance was 58kms with females relatively have to travel further as much as 60kms. 

The difference between males and females in terms of duration of diagnosis have been insignificant and the mean duration is less than half a year. The mean cumulative expenditure throughout the survey is Rs. 93,010. And the difference between both is statistically significant.

To conduct the covariate analysis empirical models and methods were used which can be studied in detail in particular reference to the article itself. As the description of the method is out of my academic skills and understanding.

Results:

The results derived suggested that duration has a significant positive impact on both dependent variables. The later the patient reaches the center, the more the expenditure. An educated individual has higher cumulative total and medical expenditure and household size also positively impacts the medical bot, not total expenditure.

Results also show that for female patient mean cumulative expenditure is less by Rs.23,698, and therefor 73% of the difference in expenditure can be explained by gender discrimination. It is important to note that the study took place in a public hospital and the private sector also offers the treatment of cancer which is more expensive and the discrimination can be even larger in there.

Gender differences also increased with age in terms of expenditure. A plausible explanation is that the older men might have control over their savings but women might not. The most striking findings are the negative intersectionality of the old age, poverty, and joint family’s effect on exaggerating the gender differences and discrimination.

Understandings and reflections:

The study has been conducted in detail and the choice of topic is converging social, economical, demographical broadly the social determinants of health and their implication on diving discrimination between gender(5). The academic knowledge which can be connected with the article is the importance of the societal issues and further deepening of that by the level of poverty, types of family, and the status of women in the family/society(6). From the economic perspective by the definition of scarcity and making choices it is evident that spending the resources on the women is being delayed as it is being described in terms of tuberculosis diagnosis in the introduction section. The choice of spending the resources on cancer treatment which is a grave disease also shows the discrimination than one interesting topic of further research will be why it is so important for a woman to be so seriously ill and then and then the consideration of the treatment is taken. The likelier outcome is women reaching for the cancer treatment in advance stage. Also, the later the treatment, the more the cumulative expenditure. So the negative externalities of treatment can also be connected with the higher cumulative expenditure in the family which comes from poor socio-economic background.

 

 

 

 

Contribution:

As the article follow the various aspect of economic background the understanding and considering the different variables and which aspect to take into account is one of the important things it contributes. The language is beginner’s friendly and even with someone of basic economic knowledge can understand the substance of the article. It is also the article which can be studied by the social and behavioral scientist to study the intersectionality and effect of the various factors onto the choices and converging economic and social aspect and how the economic decisions are largely influenced by cultural aspects. It is one more evidence that is contributing to the growing literature of gender discrimination and especially study in adults. The contribution in the Non-communicable diseases and data is of significant importance as the studies have been done on diabetes and cardiovascular disease but on cancer the literature is still lesser in comparison to both the diseases. 

Scope of the research:

This paper is one of the few papers of economic perspective in gender discrimination and similar studies can be undertaken for urban setting as India is rapidly urbanizing country. The policy analysis for a various decision regarding the healthcare provision through government settings and information asymmetry for the diagnosis and impact of NCDs on the poor household is something to probe upon.

 

 

 

 

References:

1.         Baeten S, van Ourti T, van Doorslaer E. Rising Inequalities in Income and Health in China: Who is Left Behind? SSRN Electronic Journal. 2012 Sep 12;

2.         Zhou L, Chen X, Lei L. Intra-household allocation of nutrients in an opening China. International Journal of Environmental Research and Public Health. 2018 Apr 9;15(4).

3.         Asfaw A, Klasen S, Lamanna F. Intra-Household Gender Disparities in Children’s Medical Care Before Death in India. SSRN Electronic Journal. 2011 Dec 28;

4.         Asfaw A, Lamanna F, Klasen S. Gender gap in parents’ financing strategy for hospitalization of their children: Evidence from india. Health Economics. 2010 Mar;19(3):265–79.

5.         Denton M, Prus S, Walters V. Gender differences in health: A Canadian study of the psychosocial, structural and behavioural determinants of health. Social Science and Medicine. 2004 Jun;58(12):2585–600.

6.         MODULE 4: ECONOMIC, SOCIAL AND CULTURAL RIGHTS OF WOMEN [Internet]. [cited 2020 Apr 30]. Available from: http://hrlibrary.umn.edu/edumat/IHRIP/circle/modules/module4.htm