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Sex differences in utilisation of hospital care in a state-sponsored health insurance programme providing access to free services in South India
  1. Maaz Shaikh1,
  2. Sanne A E Peters2,
  3. Mark Woodward2,3,
  4. Robyn Norton2,3,
  5. Vivekanand Jha1,2
  1. 1 The George Institute for Global Health, New Delhi, India
  2. 2 The George Institute for Global Health, University of Oxford, Oxford, UK
  3. 3 The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Dr Sanne A E Peters; sanne.peters{at}


Background Universal healthcare coverage provides healthcare and financial protection to all citizens and might help to facilitate gender equity in care. We assessed the utilisation of hospital care services among women and men in a large underprivileged population with access to free hospital care in India.

Methods The Rajiv Aarogyasri Community Health Insurance Scheme, a state-sponsored scheme, provided access to free hospital care for poor households across undivided Andhra Pradesh. Claims data for hospitalisations between 2008 and 2012 were analysed to determine the number of individuals, hospitalisations, bed-days and hospital expenditure for sex-specific and sex-neutral conditions, by sex, disease category and age group.

Results A total of 961 442 individuals (43% women), 1 223 723 hospitalisations (48% women), 7.7 million bed-days (47% women) and hospital expenditure of US$579.3 million (42% women) were recorded. Sex-specific conditions accounted for 27% of hospitalisations, 12% of bed-days and 15% of costs for women, compared with 5%, 4% and 4% in men. Women had a lower share of hospitalisations (42%), bed-days (45%) and costs (39%) for sex-neutral conditions than men. These findings were observed across 14 of 18 disease categories and across all age groups, but especially for older and younger women.

Interpretation In this large underprivileged population in India with access to free hospital care, utilisation of hospital care differed for women and men. For sex-neutral conditions, women accessed a smaller proportion of care than men, suggesting that coverage of hospital care alone is not sufficient to guarantee gender equity in access to healthcare.

  • health policy
  • public health
  • epidemiology

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  • Handling editor Seye Abimbola

  • Contributors MW, RN and VJ conceived the research. MS performed the statistical analyses. MS and SAEP drafted the article. All authors contributed critical intellectual content and made important revisions to the manuscript.

  • Funding SAEP is supported by a UK Medical Research Council Skills Development Fellowship (MR/P014550/1).

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.