Does catastrophic health spending widen the gender divide in healthcare for non-communicable diseases in India? Insights from decomposition analysis

Problem Considered Non-communicable diseases (NCDs) are the leading cause of mortality in India, often causing high costs and catastrophic health impacts. However, gender disparities in healthcare expenses among hospitalized NCD patients in India remain unexplored in existing literature. Therefore, the study examines the magnitude of gender gap in the average of total healthcare expenses (ATHE) and the contributing factors to this gender gap among hospitalized NCD patients in India. Methods Data used from India's latest 75th National Sample Survey (2020) on Health in India, focusing on 28,897 inpatients hospitalized for NCDs. Descriptive statistics and cross-sectional analysis were performed to identify hospitalization cases and healthcare expenses of NCD patients. Oaxaca-Blinder decomposition method is employed to examine gender differences in ATHE, dividing it into explained (endowment) and unexplained (coefficient and interaction) components. Results Men's ATHEs are significantly higher than women's, with an average annual difference of ₹9,754 (US$ 111). Socioeconomic and health factors accounted for 70.5% of the gender gap, while 29.5% remained unexplained, possibly due to gender bias. Among NCDs, gender disparities in spending were notable in ATHE for patients with cardiovascular diseases, cancers, gastrointestinal diseases, and diabetes. The largest gender gap is attributable to households experiencing catastrophic health expenditures (CHE). Conclusion The gender gap in ATHE for NCDs in India arises from structural inequalities and potential gender bias. Households experiencing CHE reflect inequities in women's healthcare needs. Strengthening gender-sensitive financial protection mechanisms and improving access to affordable healthcare may help reduce these disparities and promote more equitable health outcomes.