ENGENDERED ACCESS OR ENGENDERED CARE ? Evidence from a Major Indian Hospital

A central feature of many developing countries is the presence of significant gender differentials in health outcomes. Two potential factors that can account for this are that females access treatment later than males and that they receive differential care at the medical facility. We explore both of these in the context of eye care. We study diagnostic and surgical outcomes of 60,000 patients who sought treatment over a 3-month period in 2012 at the Aravind Eye Hospital in India. Our results show that at presentation, women have worse diagnoses than men for indicators of symptomatic illness. They have lower visual acuity and pinhole visual acuity, are more likely to be sight-impaired, are more likely to be advised surgery, or diagnosed for cataract. Significant gender differentials are, however, absent in “best-corrected" visual acuity and the bulk of the evidence indicates no significant gender differences in other indicators of surgical care — time to surgery, surgery duration, the incidence of post-operative complications, and the seniority of attending medical personnel. For asymptomatic disease, there is no significant difference between males and females when looking at two correlates of glaucoma: intraocular eye pressure and a high cup-to-disk ratio. To resolve gender-based health inequalities in developing countries, we need to know where these inequalities lie. We find them in access but not care. The findings for symptomatic illness suggest that women seek treatment later than men for symptomatic illness. That no such gender differential exists for asymptomatic disease suggests that women do not necessarily go for regular preventive checkups at a lower frequency than men. We find no systematic evidence that women and men receive differential medical treatment. 1 We are very grateful to the staff of Aravind Eye Hospital, in particular Ganesh Babu and R.D. Thulsiraj for their support and collaboration. We thank Abraham Holland and Misha Sharma at the Center for Microfinance for providing invaluable local project management, Amelie Schiprowski for excellent research assistance, and Dr. Tomasz Mlynczak for his medical expertise. We thank an anonymous referee for useful comments. Ray acknowedges funding from the National Science Foundation of the United States under grant SES-1261560. We are also grateful to the International Growth Centre for partial funding of this research.