Breaking down Gender Inequities in Health Insurance Coverage for Non-Communicable Diseases: A Fairlie Decomposition Study

Rishika Tomar, Indian Institute of Technology Roorkee, Roorkee
Ankita Sharma, Manipal University
Pratap Mohanty

India bears a disproportionately large and regressive burden of out-of-pocket expenditure (OOPE) for the treatment of Non-Communicable Diseases. As a precautionary measure, enrolment in health insurance (HI) can effectively cope with the OOPE burden for NCDs. Gender inequality in HI is a major concern in India. The present study focuses on a gender-disaggregated analysis of the patients hospitalized for NCDs and their coverage by HI schemes at the national and state levels. The study also examined the socioeconomic, demographic, and healthcare factors that explain the gender gap in HI for hospitalized NCD patients by performing a Fairlie decomposition analysis. The study utilizes the 75th round of India's nationally representative large-scale survey data for 2017-18. The findings suggest that states having the lowest epidemiological transition level (ETL), i.e., more burden of NCDs, such as Bihar, Jharkhand, Madhya Pradesh, Orissa, and Uttar Pradesh, have the lowest insurance enrolment for both males and females, except for Chhattisgarh and Rajasthan. The highest gender gap in HI enrollment is in the state of Goa (Highest ETL group). The major contributors to the gender gap in HI are persons belonging to forward classes, married individuals, and patients who spent on medicines and hospitalization in different districts.

Keywords: Health and Morbidity, Gender Dynamics, Inequality, Disadvantage and Discrimination, Families, Unions and Households

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