According to the Periodic Labour Force Survey of April-June, 2020, the labour force participation of women in urban areas (age above 15 years) was 19.6. According to International Labour Organization (ILO), in 2021 it was 22.3. This may cause financial dependence of women on other members especially male members of the family. Also, India has high out-of-pocket expenditure (India 62.6, Pakistan 56.2, Nepal 50.8, China 35.7) and a very low level of public expenditure on health as percentage of GDP 1.3 percent, according to Economic Survey (2021-22).
Even though there are many health insurance schemes of various types, reimbursements from employers for medical bills and Central and State Government-sponsored Health Schemes, private health insurance, etc. exist in India. As the non-communicable diseases (NCDs) are increasing among women, which require long-term (sometimes lifelong treatment), and health checkups which can cause a heavy burden on women and their families; there are very few studies that have exclusively focused on the health expenditure of women at the micro level.
A primary survey was conducted to understand the health-seeking behaviour of women according to various socio-economic factors. The area under study is Mumbai and its suburbs. The wards in Mumbai and specific locations in Mumbai were selected by purposive sampling so that all the regions in Mumbai and all the nodes in the Navi Mumbai Municipal Corporation (NMMC) are covered in the study.
Access to Health care services
The results of the study showed that health checkup is positively related to having health insurance, and occupational status (employed). When women have health insurance and are employed, they go for health checkups.
“I don’t have any problem” was the reason in the highest proportion given by the women for not going for health checkups.
‘Affordability problems’ were the reason given by women who had chronic illnesses.
It was found that 66.5 percent were admitted for chronic diseases and 44 percent; of the cost of medicines was found to be the costliest for any type of illness during hospitalization.
Health Insurance and Source of Payment during Hospitalization
It was seen that 44.5 percent of women are aware of health insurance and only 16.1 percent have health insurance. It was seen through analysis that awareness about health insurance can increase the demand for health insurance. Younger women demand for health insurance more than older women. For hospitalization, the highest source of payment was the husband’s savings. Even employed and insured women opted for this source of payment during hospitalization.
Health Score and Health Status
The health score to measure the health status of the sample women was calculated by using Principal Component Analysis (PCA) and Z score. The health score is taken as a proxy for the health status of women. The average health score is increasing as income and education are increasing. As age increases, the average health score decreases. For age of the respondent during the birth of the first child, the health score is less, for less than 18 years and 19-30 it is high and towards the higher age group it decreases. The analysis of the primary data shows that, if the women are employed their health status improves, and if they have health insurance, then their health status improves.
A very high percentage of women do not go for health check-ups (76 percent). Analysis of primary data brought out that those women who are employed, and have health insurance have an increased chance of doing health check-ups.
Results of FGDs
The Focus Groups Discussions (FGDs) showed that more than half of the women did not have health insurance, and even those who had insurance, did not avail the benefit of it either due to ignorance or procedural delays, or lack of awareness regarding the paperwork to be done. Women thought that it is a waste of money to take health insurance and they did not have proper information on how insurance allows risk pooling and gives support during sickness. Many were unaware of where they can get health insurance.
There is also the issue of a lack of doctors in public hospitals. Women expressed these issues when they went to public hospitals: crowded hospitals, long waiting times, non-availability of emergency care, same medicine for all illnesses, diagnostic tests are not done on time, the nurses and doctors being hostile, and the staff not treating patients well. They expressed these demands: proper facilities of medical checkups, reduce crowding in the hospitals, better technology, and medical equipment, improved facilities at low cost, and an empathetic attitude of the health personnel.
Firstly better dissemination of information about health schemes; many families are falling into poverty due to high out-of-pocket expenditures, as they do not have proper knowledge about the schemes and insurance. Also reducing the requirement of some documentation from the poor might help. Improving the quality of health services and better services of health personnel and infrastructure of public hospitals is also the need of the hour.
During hospitalization, mostly the source of payment of hospital bills is savings of the household, so better financing options in form of insurance schemes with the cashless option should be encouraged for the lower income groups. Effective universal health coverage and a national health protection scheme can be very useful to have an impact on the health of most of the urban poor in our country.
As a way forward, a comparative analysis of the implementation of Ayushman Bharat vis-a-vis some existing state insurance schemes can provide very useful insights into health policy for the urban poor including women from marginalized groups.
Research done by comparing health-seeking behavior in rural and urban areas can give insights into the rural-urban differences as well as some similarities. Also comparing the health-seeking behavior of women in metropolitan cities like Mumbai to other urban or emerging cities in the country would be useful. This can certainly be an important area of future research.
Gender equality, good health, and well-being all feature in the Sustainable Development Goals (SDGs), and the disparity experienced in women’s health-seeking behaviour are alarming. With health gaining centrality like never before due to the advent of the pandemic, the issue of negligence regarding this subject needs to be discussed and addressed.
Like the slogan “Healthy Women, Healthy World” their health and well-being are directly linked to the well-being of the household unit. Under the series, the State of Gender Equality – #GenderGaps, Gender Impact Studies Center (GISC), IMPRI, Impact and Policy Research Institute, New Delhi organized a #WebPolicyTalk, on the topic A Socio-Economic Analysis of Health Seeking Behaviour of Women in an Urban Area with Special Reference to their Employment Status by on November 30, 2022.
Dr. Lakshmi Priya is an Independent Researcher, who worked as a Research Coordinator at IRIS Knowledge Foundation for 11 years and anchored TATA Trust and GATES foundation projects.