Principal Investigators: Rajshri Jayaraman & Debraj Ray
Research Team: Misha Sharma & Parul Agarwal
LEAD Centre: Centre for Microfinance (CMF)
Focus Area: Livelihoods
Project Geography: Tamil Nadu, India
Partner: Aravind Hostpitals
Status: Completed


Starting with the work of Ansley Coale and Amartya Sen, a large literature has developed on “missing women”: the existence of abnormal sex ratios (favoring males) in many parts of the developing world, notably in India and China. While much of this literature has emphasized a skewed sex ratio at birth and the attendant possibility of significant sex-selective abortion, recent research argues that the problem is widespread over a variety of age and disease categories. At the same time, the particular channels of non-infant gender bias are largely unknown, and could stem from a variety of causes, including lifestyle differences, diet, stress or inattention to health. This study takes a step in understanding these pathways by asking whether females seek medical care at systematically lower rates than males.
The major objectives to the study are: First, document gender differences in health-care, specifically, in waiting times to first treatment. Using measures of disease intensity (see above), we will evaluate the extent to which eye health has deteriorated before men and women seek care. Second, document gender differences in the probability of follow-up visits conditional on similar levels of health at the first stage of evaluation. Third, understand the underlying reasons for the observed health differences across gender. It is obvious that a plethora of factors must come into play. Without underestimating the importance of any of these, the researchers emphasize the economics of gender differentials in care. Specifically, they propose a careful economic analysis of how the costs faced by households affect the decisions of men and women to seek care.

Research Methodology
To address these questions, we will conduct econometric analysis (and in particular, multivariate regression analysis) using data that that will be assembled from Aravind’s administrative records on patients who arrived at the paying hospital, the free hospital, the vision centers and the eye camps. At a later stage of the study, a detailed household survey will be conducted among randomly selected Aravind patients to understand the reasons for gender differentials in seeking of health care.

Study Status
Currently the first phase of the study is complete, wherein Aravind patient records have been collected from different streams (paid, subsidized, free). The study is now gearing for a household survey among randomly selected Aravind patients.

Related Resources
POLICY MEMO – Informing policy: Gender differences in healthcare outcomes