New Delhi: Poor local healthcare infrastructure in Bihar, Uttar Pradesh and Haryana have led to an increased flow of patients to the All India Institute of Medical Sciences (AIIMS) in Delhi, a study by doctors at the prestigious hospital, and experts at the Indian Statistical Institute, Harvard University and the Prime Minister’s Economic Advisory Council concluded.
The study is also a critical intervention in defining a gender-related health policy in the country, as women in the age group of 19-30 years, among all outpatients visiting AIIMS, have been found to be unable to access healthcare facilities.
News18 spoke to Shamika Ravi, one of the authors of the study and member of the Prime Minister’s Economic Advisory Council (PMEAC), to comprehensively understand the findings.
“The fundamental difference among women exists between the younger and older age groups: those below 20 and above 50. Within these age groups, very few women are being brought to the hospital. These are the women in their reproductive or productive age who are not being given tertiary healthcare. This gender gap systematically worsens with increasing distance from the hospital, in this case, AIIMS,” she said.
To arrive at the given conclusion, the experts “used data on clinical appointments from 2,377,028 outpatients” to analyse the sex ratio of patients from Bihar, UP, Haryana and Delhi. Variations of this ratio are adjusted with respect to distance from the hospital and the age of the patient.
“This is a large hospital with more than 2 million annual outpatient visits and a large referral base from the states studied,” the report stated on its rationale to choose AIIMS for the research.
The lead author of the study, Mudit Kapoor of the Indian Statistical Institute, spoke to News18, explaining the first-ever inter-disciplinary methodology adapted for the study.
“We were motivated by two broad questions. One, if the cost of healthcare increases are women, more than men, not likely to be brought to hospitals. Two, in the presence of increased costs, are households more likely to send men than women for treatment. We approached this both from a policy and mathematical perspective because the location of the healthcare facility matters,” he said.
In 2016, AIIMS witnessed an inflow of 8,82,324 patients from the aforementioned states, who visited the hospital 2.69 times. Of these visitors, 63 per cent were male patients and 37 per cent female patients. So, the total male-female outpatient visit ratio at AIIMS stands at 1.69 – a figure higher than the overall sex ratio of the population.
According to the study, the sex ratio has a U-shaped relation with age. For instance, the ratio is higher for younger age groups: 0-18 years (1.94) and 19-30 years (2.02). It declines to less than 1.50 for the middle age groups 31-44 years and 45-59 years. For patients 60 years and older, the ratio increases to 1.72.
What this essentially means is that individuals aged below 30 and those aged above 60 are more likely to travel outside their states to access healthcare facilities. According to Kapoor, women from younger and older age groups are more discriminated in terms of access to healthcare because of the increased costs due to the need of another person accompanying them.
Indeed, adding to the above findings are the variations in sex ratio when compared to the distance of residence of patients.
“The sex ratio of patients from Bihar, which is the furthest state from Delhi, was 2.37; it declined to 2.10 for patients coming from Uttar Pradesh, which is closer to Delhi compared with Bihar; it declined further to 1.68 for Haryana, which is the adjoining state to Delhi; and was the lowest for Delhi at 1.37,” the report said.
Thus, in the absence of local healthcare infrastructure, younger and older persons from Bihar, followed by UP and Haryana, travel the furthest to avail medical treatment. Conversely, age groups of 31-44 years and 45-59 years have the lowest sex ratio across all outpatients at AIIMS.
The study also helps fill the gap in the gendered perspective of healthcare by stating that women outpatients are most prone to discrimination in availing health facilities. It reaches this conclusion by equating the sex ratio of the four states with the sex ratio of the total census population.
Experts found that 4,02,772 women failed to avail healthcare facilities at AIIMS. This figure totals to 49 per cent of total female outpatients for these four states, the study noted.
Breaking down this figure as per states shows that Uttar Pradesh has the highest number of women (1,61,533) lacking access to healthcare at AIIMS, followed by Bihar at 1,00,943 and Haryana at 40,748.
In terms of age, women unable to visit a doctor comprise mainly the age group 0-18 years and 19-30 years in Bihar and Uttar Pradesh. While Bihar and UP are not in close proximity to Delhi, the bordering state of Haryana has a different set of indicators. Women who are aged 60 years or older are most prone to discrimination in availing healthcare facilities.
Shamika said building a local healthcare community will help women more, and thus reduce the gender gap in access to it. “From a policy, when we seek the establishment of new hospitals, school or other institutions, we often forget about its strong gender impact. The intent is not to reduce gender gap, but to provide facilities. But, in return, it affects women,” she added.
“This calls for systemic societal and governmental action to correct this gender discrimination,” the report notes.
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