Sex differences in utilization of hospital care in a state-sponsored health insurance program providing access to free services in south India

Background Universal healthcare coverage provides health care and financial protection to all citizens and might help to facilitate gender equity in care. We assessed the utilization 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 hospitalizations between 2008 and 2012 were analysed to determine the number of individuals, hospitalizations, 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 hospitalizations (48% women), 7.7 million bed-days (47% women), and hospital expenditure of 579.3 million USD (42% women) were recorded. Sex-specific conditions accounted for 27% of hospitalizations, 12% of bed-days and 15% of costs for women, compared with 5%, 4% and 4% in men. Women had a lower share of hospitalizations (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, utilization 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.