Providing free hospital care is not enough to ensure equal access by women

Providing access to free hospital care may not ensure equal access between women and men, an analysis of data on nearly 19 million households in South India by researchers at The George Institute for Global Health in India and at the University of Oxford suggests.

Despite a state-sponsored insurance scheme, which provided access to free hospital care for poor households across the state of Andhra Pradesh, a smaller proportion of women than men received hospital care for sex-neutral conditions across all age groups and most disease categories.

‘Our findings have urgent implications for the current drive towards achieving Universal Healthcare Coverage around the world, which we would expect to be of huge benefit for women,’ said Dr Sanne Peters, Research Fellow in Epidemiology at The George Institute, Oxford.

‘It seems that ensuring that everyone can access essential healthcare services, without incurring financial hardship, is not enough on its own to ensure equal access by women and men. We need to consider other barriers that women might face in accessing healthcare, which may include families prioritising the healthcare needs of men over those of women.’

The new study analysed claims data on hospitalisations between 2008 and 2012 from the largest state-funded health insurance scheme in India, in undivided Andhra Pradesh (the state was split into Andhra Pradesh and Telangana in June 2014).

It found that despite comparable proportions of women and men in the population, women had a lower share of hospitalisations (42%), bed-days (45%) and hospital costs (39%) for sex-neutral conditions than men. These findings were observed across 14 of 18 disease categories and all age groups, but especially for the oldest and youngest women.

‘India has one of the highest levels of gender inequality in the world, and as the benefits of this insurance scheme are shared within households, it could be that the healthcare needs of girls and women – particularly those not of reproductive age – are considered less important than those of their brothers, fathers and husbands,’ said Professor Vivekanand Jha, Executive Director of The George Institute for Global Health in India.

At least half of the world’s population does not have full coverage of essential health services, and about 100 million people are pushed into extreme poverty every year because they have to pay for healthcare. As women are the majority of the world’s poor and therefore less able to afford healthcare than men, Universal Healthcare Coverage – one of the targets of the Sustainable Development Goals – is widely seen as a strategy to improve gender equality.

‘Our new findings suggest that unless policymakers pay explicit attention to the barriers women face to accessing healthcare, progress towards Universal Healthcare Coverage alone may not be enough to achieve equal access to essential services by all,’ said Professor Robyn Norton, Principal Director of The George Institute for Global Health and Acting Executive Director of The George Institute, Oxford.

Read the full study article in BMJ Global Health.