Patterns of Gender inequality in Health Care Utilization

As it is the case in most developing countries, illness may not necessarily lead to demand for medical care in India owing to various reasons. First, some households who reported illness of children might not think that they need medical help. Second, even those households who perceived health problem of their children and the need for medical help might not be able to translate this need into effective demand. As a result, there can be variation between perceived illness and actual demand for health care. This discrepancy can have different effect on the probability of getting medical help between boys and girls if parents have special sex preference.

Both the 42^nd (conducted in 1986) and 52^nd

After a decade, the proportion of children treated for sickness reported during the last 15 days before the survey increased by 1 percentage point to 86.21 percent. More interestingly, while the percentage of boys treated did not show significant change between 1986 and 1996, the percentage of girls treated increased by 2 percentage points from 83.24 to 85.25 percent. As Table 3.1 shows, this change was observed in almost all age categories, particularly in the infant age category.

(conducted in 1996) Indian NSSs collected information on whether each household member suffered from any ailment during last 15 days preceding the day of survey, and whether the ailment was treated or not. In 1986, out of 12,717 children who were sick, 85 percent got medical help. There was statistically significant difference in seeking medical help given illness between boys and girls. Only 83 percent of girls got medial attention given illness compared to 86 percent of boys and this difference was statistically significant (Chi2 = 23.64 and significant at 0.00 level). This difference holds for all age categories as shown in Table 3.1.

Table 3.1 Percentage of children treated for sickness reported during the last 15 days

Source: Computed form the 42^nd and 52^nd Indian National Sample Survey

Health expenses given illness

While expenses incurred for treatment of ailments such as purchase of medicines, diagnostic tests, consultation fees, etc., may not significantly vary by gender (since they usually depend on the decision of medical practitioners), expenses on other non-medical health expenses such as transport other than ambulance, lodging charges of escort(s), attendant charges, personal medical appliances, etc., can significantly vary by gender. In other words, the decision to buy non-medical services can be influenced by parental gender preferences.

Table 3.2 presents expenses related to non-medical health costs incurred for treatment of ailments (out-patient) by sex, age group, and year. In 1986, parents spent 28.7 percent more money for non-medical health expenditure of boys than for girls and this difference was statistically significant (F-test 11.77 and significant at 0.00 levels). As table 2 shows, this gender biased non-medical health expenditure was much higher in the infant age category (0-1) than in the other two age groups. Parents’ non-medical spending for infant boys was 43.4 percent higher than for infant girls.

Out-patient non-medical health expenses

After ten years, this discrepancy has declined significantly and the amount of non-medical out-patient health investment on boys was only 21 percent higher than that of on girls. This improvement was highly profound in the infant age group. Parents spent only 7 percent more for infant boys than for infant girls in 1996 and the difference was no longer statistically significant as shown in Table 3.2.

Table 3.2 Non-medical out-patient health expenses (in Rupees.) for boys and girls

Age category 1986 1996

Boys Girls ANOVA F-test (pr.)

Boys Girls ANOVA F-test (pr.) 0-1 years 68.56 47.81 12.20 (0.00) 43.55 35.77 0.41 (0.52 2-4 years 70.32 56.3 2.38 (0.12) 36.86 34.18 6.86 (0.00) 5-9 years 71.51 57.47 3.61 (0.05) 43.34 30.16 1.10 (0.29) Total 70.29 54.63 11.77 (0.00) 52.33 42.58 0.63 (0.42)

Source: Computed form the 42^nd and 52^nd Indian National Sample Survey

Significant improvement was also observed in the amount of non-medical in-patient health expenses between 1986 and 1996 (see Table 3.3). Parents spent nearly 30 percent more on non-medial expenses for hospitalized boys than for hospitalized girls in 1986. This discrepancy, however, declined to 24.8 percent in 1996. Significant decline was observed again in the infant age groups as the table shows. While parents’ non-medical in-patient expenditure on infant boys was 102 percent higher than on infant girls in 1986, it declined to 22.8 percent in 1996.

In-patient non-medical health expenses

Table 3.3 Non-medical in-patient health expenses (in Rs.) for boys and girls

Age category 1986 1996

Boys Girls ANOVA F-test (pr.)

Boys Girls ANOVA F-test (pr.) 0-1 years 155.61 77.75 5.76 (0.00) 210.03 171.00 1.07 (0.30) 2-4 years 145.79 91.43 3.38 (0.00) 307.35 206.24 3.30 (0.06) 5-9 years 256.22 241.27 0.01 (0.90) 293.04 252.63 0.92 (0.33) Total 191.80 147.83 0.72 (0.30) 273.89 219.52 4.12 (0.04)

Source: Computed form the 42^nd and 52^nd Indian National Sample Survey

Significant variation was observed in the proportion of girls who got medical help given illness compared to boys across states. The first two columns of Table 3.4 present the ratio of the percentage of boys (compared to girls) treated for sickness reported during the last 15 days before each survey by state. The third column gives the percentage change. Negative values indicate an improvement in the proportion of girls treated compared to boys during the time under consideration. States such as Orissa, Assam, Madhya Pradesh, Uttar Pradesh, Jammu Kashmir, Tamil Nadu, and Maharashtra have Patterns across states

shown significant improvement in the proportion of girls treated compared to boys between 1986 and 1996.

Table 3.4 Patterns of access to health care and sex ratio in 1986 & 1996 by state State Ratio of percentage of boys

treated compared to girls

Source: Computed form the 42^nd and 52^nd Indian National Sample Survey

As shown in the last three columns of the table, these states have also achieved significant reduction in their child sex ratio during the time under consideration. States such as Kerala, Rajasthan, etc., who have achieved equal access of health care to both boys and girls have significant improvement in child sex ratio. Interestingly, states with high gender discrimination in getting medical help or states who did not achieve significant improvements in the proportion of girls treated compared to boys such as Punjab, Himachal Pradesh, Haryana, and Tripura did not show a reduction in the child sex ratio during the time under consideration.