International Institute for Population Sciences, Mumbai, India.
International Institute for Population Sciences, Mumbai, India.
Soc Sci Med. 2020 Sep;260:113222. doi: 10.1016/j.socscimed.2020.113222. Epub 2020 Jul 17.
Studies from India have documented gender differentials in hospitalization financing. Much of this work focused either on children or adults, but not across age-groups. No research to date has focused on gender differentials in case of catastrophic hospitalization expenditures. This study assesses gender differentials in distressed financing (borrowing, selling of assets, contributions from relatives or friends) for hospitalization in cases of catastrophic expenditures for hospitalization in India, for young, adult and older adult patients.
We conducted a cross-sectional analysis of India's 2017-18 National Sample Survey, which collected data on hospitalization and expenditures. We used multivariable probit regression and adjusted marginal effects to assess the associations between gender and the use of distressed financing for catastrophic hospitalization expenditures. Models were stratified by age, and run both with and without sample selection. Secondary analyses assessed gender differentials in the use of distressed financing for hospitalization in case of health insurance cover or not.
Multivariable sample selection-adjusted probit regression shows that in households which incurred severe catastrophic hospitalization expenditures, the probability of using distressed financing for hospitalization of young or older females was 10% points lower than their male counterparts. In households which did not incur severe catastrophic hospitalization expenditures, there was no significant gender differential in use of distressed financing for hospitalization for any age group. In households which incurred severe catastrophic hospitalization expenditures, the probability of using distressed financing for hospitalization was lower for older females than for older males irrespective of health insurance cover.
There appears to be a clear gender discrimination in distressed financing of hospitalization costs among younger and older individuals in households that incurred severe catastrophic hospitalization expenditures in India. Health systems should consider how to otherwise support necessary hospitalization financing for girls and older women.
印度的研究记录了住院融资中的性别差异。其中大部分工作要么针对儿童，要么针对成年人，但没有针对不同年龄组。迄今为止，没有研究关注灾难性住院支出情况下的性别差异。本研究评估了印度灾难性住院支出情况下，年轻、成年和老年患者的住院困境融资（借款、资产出售、亲属或朋友的捐款）中的性别差异。
我们对印度 2017-18 年国家抽样调查进行了横断面分析，该调查收集了住院和支出数据。我们使用多变量概率回归和调整边际效应来评估性别与灾难性住院支出困境融资使用之间的关联。模型按年龄分层，并在有和没有样本选择的情况下运行。二次分析评估了在有或没有医疗保险覆盖的情况下，性别差异在因健康保险而住院时使用困境融资的情况。
多变量样本选择调整概率回归显示，在发生严重灾难性住院支出的家庭中，年轻或老年女性为住院使用困境融资的概率比男性低 10 个百分点。在未发生严重灾难性住院支出的家庭中，任何年龄组在使用困境融资住院方面没有显著的性别差异。在发生严重灾难性住院支出的家庭中，无论是否有医疗保险，老年女性使用困境融资住院的概率都低于老年男性。
在印度，发生严重灾难性住院支出的家庭中，年轻和老年个体的住院费用困境融资中似乎存在明显的性别歧视。卫生系统应考虑如何以其他方式为女孩和老年妇女提供必要的住院融资支持。
