‘Communities and countries and ultimately the world are only as strong as the health of their women,’ said Michelle Obama. Globally, women’s health financing facing added challenges, but in India, it is a particularly complex and multifaceted issue. Healthcare Expenditure (HCE) is influenced by a range of factors, including socio-economic disparities and cultural norms. However, it is the single most important factor that impacts quality healthcare for women across the country. Despite government initiatives across the board, women face challenges in ensuring equitable health financing.
‘There are Government schemes like the Rashtriya Swasthya Bima Yojana (RSBY) that aim to provide health insurance to low-income families,’ explains Dr Joannah V Nathan, who works at a Government Hospital in Tamil Nadu. ‘However, enrollment rates among women remain low.’ She adds, ‘Women from marginalised communities and low-income groups also remain woefully unaware about health insurance schemes and lack financial literacy. They are therefore unable to control healthcare financing. Even if they do opt for health insurance schemes, these may not cover areas related to women’s health such as reproductive and maternal services. If left untreated, women suffer from poor quality of life, disability, and chronic ailments. Change begins with basic awareness – that they have to prioritise their health, that prevention is cheaper than cure, and that they need to make some kind of provision for medical expenses.’
According to research published in the journal ‘Science Direct’, ‘numerous studies address the health care financing strategies of households in developing countries. In general, in many low- and middle-income countries, people tend to pay for individual healthcare from their own pockets rather than from insurance or government-aided health schemes. Therefore, a financing strategy to cover the cost of illness is affected by a household's economic status and by the type, severity, and duration of the illness. Households in developing countries use a wide range of strategies to afford health care services and manage the economic burden of health care. One of the first strategies that families utilize to meet healthcare costs is to use currently available income and savings. Nearly half of total households deal with the financial cost of an illness through their available income or by using cash reserves.’
In addition, the article says that out-of-pocket HCE in India is the highest in the world. Around 58 per cent of households finance inpatient care through borrowing, sale of assets, and contributions from friends and relatives. Do health care financing strategies differ systematically for men and women in India? Studies show that HCE was systematically lower for women than for men across all socioeconomic subgroups, despite women having a higher prevalence of morbidity than men.
On average, women also earn lesser than men, and this pay disparity places them at a greater financial disadvantage. However, the Government of India has made strides with various schemes in maternal care. According to the Ministry of Health and Family Welfare, these include:
• Surakshit Matritva Aashwasan (SUMAN), providing assured, dignified, respectful, and quality healthcare at no cost and zero tolerance for denial of services for every woman and newborn visiting public health facilities to end all preventable maternal and newborn deaths.
• Janani Suraksha Yojana (JSY), a demand promotion and conditional cash transfer scheme for promoting institutional delivery.
• Janani Shishu Suraksha Karyakram (JSSK), where every pregnant woman is entitled to free delivery, including caesarean section, in public health institutions along with the provision of free transport, diagnostics, medicines, blood, other consumables, and diet.
• Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), providing pregnant women with free-of-cost assured and quality antenatal checkups by a specialist/medical officer on the 9th day of every month.
• First Referral Units (FRUs) that ensure manpower, blood storage units, and referral linkages to improve access to quality care for pregnant women.
The Way Forward
1. Increasing public health expenditure and allotting more resources to women can eliminate barriers for girls and women in rural and semi-urban areas to access healthcare.
2. Women can leverage technology to access FinTech solutions such as health savings accounts and digital insurance products, which will help them stay prepared for contingencies.
3. Tailormade insurance schemes for women should be offered, encouraged, and implemented. These will cater to their specific and unique needs, improving health outcomes.
4. Awareness is key, and community-based educational seminars and programs can empower women with options, allowing them to make informed choices.