112 lines
3.9 KiB
YAML
112 lines
3.9 KiB
YAML
abstract: 'BackgroundThe continuing impetus for universal health coverage has given
|
|
|
|
rise to publicly funded health insurance schemes in lower-middle income
|
|
|
|
countries. However, there is insufficient understanding of how universal
|
|
|
|
health coverage schemes impact gender equality and equity. This paper
|
|
|
|
attempts to understand why utilization of a publicly funded health
|
|
|
|
insurance scheme has been found to be lower among women compared to men
|
|
|
|
in a southern Indian state. It aims to identify the gender barriers
|
|
|
|
across various social institutions that thwart the policy objectives of
|
|
|
|
providing financial protection and improved access to inpatient care for
|
|
|
|
women.MethodsA qualitative study on the Chief Minister''s Comprehensive
|
|
|
|
Health Insurance Scheme was carried out in urban and rural impoverished
|
|
|
|
localities in Tamil Nadu, a southern state in India. Thirty-three women
|
|
|
|
and 16 men who had a recent history of hospitalization and 14
|
|
|
|
stakeholders were purposefully interviewed. Transcribed interviews were
|
|
|
|
content analyzed based on Naila Kabeer''s Social Relations Framework
|
|
|
|
using gender as an analytical category.ResultsWhile unpacking the
|
|
|
|
navigation pathways of women to utilize publicly funded health insurance
|
|
|
|
to access inpatient care, gender barriers are found operating at the
|
|
|
|
household, community, and programmatic levels. Unpaid care work,
|
|
|
|
financial dependence, mobility constraints, and gender norms emerged as
|
|
|
|
the major gender-specific barriers arising from the household.
|
|
|
|
Exclusions from insurance enrollment activities at the community level
|
|
|
|
were mediated by a variety of social inequities. Market ideologies in
|
|
|
|
insurance and health, combined with poor governance by State, resulted
|
|
|
|
in out-of-pocket health expenditures, acute information asymmetry,
|
|
|
|
selective availability of care, and poor acceptability. These gender
|
|
|
|
barriers were found to be mediated by all four institutions-household,
|
|
|
|
community, market, and State-resulting in lower utilization of the
|
|
|
|
scheme by women.ConclusionsHealth policies which aim to provide
|
|
|
|
financial protection and improve access to healthcare services need to
|
|
|
|
address gender as a crucial social determinant. A gender-blind health
|
|
|
|
insurance can not only leave many pre-existing gender barriers
|
|
|
|
unaddressed but also accentuate others. This paper stresses that
|
|
|
|
universal health coverage policy and programs need to have an explicit
|
|
|
|
focus on gender and other social determinants to promote access and
|
|
|
|
equity.'
|
|
affiliation: 'RamPrakash, R (Corresponding Author), Loyola Coll Campus, Loyola Inst
|
|
Business Adm, Chennai 600034, Tamil Nadu, India.
|
|
|
|
RamPrakash, Rajalakshmi, Loyola Coll Campus, Loyola Inst Business Adm, Chennai 600034,
|
|
Tamil Nadu, India.
|
|
|
|
Lingam, Lakshmi, Inst Social Sci, VN Purav Marg, Mumbai 400088, Maharashtra, India.'
|
|
article-number: '350'
|
|
author: RamPrakash, Rajalakshmi and Lingam, Lakshmi
|
|
author-email: rajalaksh@gmail.com
|
|
author_list:
|
|
- family: RamPrakash
|
|
given: Rajalakshmi
|
|
- family: Lingam
|
|
given: Lakshmi
|
|
da: '2023-09-28'
|
|
doi: 10.1186/s12889-021-10352-4
|
|
eissn: 1471-2458
|
|
files: []
|
|
journal: BMC PUBLIC HEALTH
|
|
keywords: 'Gender; Publicly funded health insurance (PFHI); Universal health
|
|
|
|
coverage (UHC); Social relations (SR) framework; India; Gender analysis'
|
|
keywords-plus: EQUITY; CARE; INTERVIEWS; RESOURCE; GENDER; POLICY
|
|
language: English
|
|
month: FEB 12
|
|
number: '1'
|
|
number-of-cited-references: '61'
|
|
orcid-numbers: RamPrakash, Rajalakshmi/0000-0001-6785-5239
|
|
papis_id: 498cbe7b2661f28b04b0e121cbc752ee
|
|
ref: Ramprakash2021whyis
|
|
times-cited: '7'
|
|
title: 'Why is women''s utilization of a publicly funded health insurance low?: a
|
|
qualitative study in Tamil Nadu, India'
|
|
type: article
|
|
unique-id: WOS:000619749900006
|
|
usage-count-last-180-days: '2'
|
|
usage-count-since-2013: '6'
|
|
volume: '21'
|
|
web-of-science-categories: Public, Environmental \& Occupational Health
|
|
year: '2021'
|