Gender bias in hospitalization financing from borrowings, selling of assets, contribution from relatives or friends in India

Background: 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. Methods: 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. Results: 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. Conclusion: 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.