Women access treatment for symptomatic diseases later than men in developing countries

A major consequence of gender-based health inequalities in the developing world is excess female mortality, as captured by low ratios of females to males, notably in India and China. In India, unlike China, a little known and little understood fact is that much of this excess mortality is found among adult women. There are two possible explanations for this gender differential in health outcomes. One is that women seek treatment later than men. Another is that they receive worse medical treatment than men.

Rajshri Jayaraman, associate professor of economics at ESMT, examines both of these channels in a new paper entitled “Engendered access or engendered care? Evidence from a major Indian hospital,” written with Debraj Ray from NYU and Shing-Yi Wang from Wharton. One reason for analyzing eye disease is that, unlike many other diseases which rely on subjective assessments, eye disease can be measured objectively and with high precision. Another advantage is that some eye diseases are perceived clearly as they evolve, while others are not. The authors note “the distinction between symptomatic and asymptomatic diseases allowed us to separate whether gender differences in health outcomes and in seeking care were driven either by how women and men respond to the onset of illness or by gender differences in decisions to get regular, preventative checkups.”

Using data from the administrative health records of the Aravind Eye Hospital in Madurai in India, they examined 60,000 patients who sought treatment over a three-month period in 2012. Significant gender inequalities were found in the examination of symptomatic eye diseases, such as vision and cataract, which is a disease characterized by a clouding of the lens. At the time of seeking care at the Aravind Eye Hospital, women had substantially worse visual acuity and were also significantly more likely to be diagnosed for cataract. In other words, in response to eye problems whose symptoms manifest as the disease evolves, females seek medical care systematically later than males. With respect to asymptomatic diseases, there were no gender differences in two correlates of glaucoma: intraocular pressure and a high cup-to-disc ratio. This suggests that women do not necessarily go for regular preventive checkups at a lower frequency than men.

This paper is an important first step in understanding the health inequalities that exist in accessing treatment. While the results do not support gender differentials in medical treatment, the results do suggest that women seek treatment later than men. The reasons why women access treatment for symptomatic diseases later than men warrants further study.