Abstract
This paper investigates if there are gender differences in health expenditures and treatment seeking behavior among cancer patients and finds that the results are consistent with gender discrimination. Using a survey on rural patients suffering from cancer in a public tertiary health center in an Indian state Odisha, the study finds that expenditures on female patients are significantly lesser than those on males. Even after controlling for other covariates, in particular the type of cancer, demographic and socio-economic variables, 73% of the difference persists. Our paper attributes it to gender discrimination. Moreover, the biggest reason for the difference in expenditure is attributed to differences in treatment seeking and medical expenditures before coming to the tertiary center. These results are corroborated using a nationally representative survey on health for the whole country.
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Notes
MDS is a study conducted by the Centre for Global Health Research, (http://www.cghr.org) to study premature mortality in the world. It includes the study of the cause of death; of uncertified cause as well using verbal autopsy.
This is based on cancer incidence data (2006–08) and actual growth rates (2001–2011) observed in India. Source: Indiastat: http://www.indiastat.com/health/16/diseases/77/cancer/17811/stats.aspx.
Joint family is defined as a household that has more members than just the patient, his/her spouse and his/her children.
The patients reach the tertiary center at various stages of cancer (Appendix Table 6). Almost 42% of the sample reaches the hospital in Stages 0 and 1, which is consistent with the low median duration. Females reach the hospital at a relatively higher stage than males.
The classification is largely for the ease of presentation. The results in this paper are equally true for a sub sample of the three main cancers: head and neck, breast and cervix, where no such classification is done. The observations on the other cancers are too few so as to yield any robust results on their own.
The kurtosis of log scale residuals (with log of cumulative expenditure as the dependent variable and the regressors used in the analysis) is 2.96. The analogous kurtosis of log scale residuals (with log of medical expenditure as the dependent variable) is 2.75.
It is also possible that health care is cheaper in remote places. We do not take into account the price of health care.
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We wish to thank Planning and Policy Research Unit, Indian Statistical Institute and the Institute of Economic Growth for funding this study. We wish to thank Soumitra Dash, Devmani Upadhyaya and Shalini Rudra for research assistance. We wish to acknowledge the late Professor Sanghamitra Das who thought it important to study the plight of cancer patients in Odisha. The usual disclaimers apply.
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Batra, A., Gupta, I. & Mukhopadhyay, A. Gender Differences in Health Expenditure of Rural Cancer Patients: Evidence from a Public Tertiary Care Facility in India. J. Quant. Econ. 16, 615–629 (2018). https://doi.org/10.1007/s40953-017-0113-4
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DOI: https://doi.org/10.1007/s40953-017-0113-4