Anoshua Chaudhuri

Influence of socioeconomic status, wealth and financial empowerment on gender differences in health and healthcare utilization in later life: evidence from India

Empirical studies from developed countries observe that women report worse health and higher healthcare utilization than men, but the health disadvantage diminishes with age; gender differences in self-rated health often vanish or are reversed in older ages. Comparable assessments of health during later life from developing countries are limited because of the lack of large-scale surveys that include older women. Our study attempts to address the shortage of developing country studies by examining gender differences in health and healthcare utilization among older adults in India. Both ordered and binary logit specifications were used to assess significant gender differences in subjective and objective health, and healthcare utilization after controlling for demographics, medical conditions, traditional indicators of socioeconomic status like education and income, and additional wealth indicators. The wealth indicators, measured by property ownership and economic independence, are regarded as financially empowering older adults to exercise greater control over their health and well-being. Data are drawn from a nationally representative decennial socioeconomic and health survey of 120,942 Indian households conducted during 1995-1996. The study sample comprises 34,086 older men and women aged >or= 60 years. Our results indicate that older women report worse self-rated health, higher prevalence of disabilities, marginally lower chronic conditions, and lower healthcare utilization than men. The health disadvantage and lower utilization among women cannot be explained by demographics and the differential distribution of medical conditions. While successive controls for education, income, and property ownership narrows the gender gap in both health and healthcare utilization, significant differentials still persist. Upon controlling for economic independence, gender differentials disappear or are reversed, with older women having equal or better health than otherwise similar men. Financial empowerment might confer older women the health advantage reflected in developed societies by enhancing a womans ability to undertake primary and secondary prevention during the life course.

Changes in out-of-pocket payments for healthcare in Vietnam and its impact on equity in payments, 1992–2002 ☆

BACKGROUND Economic reforms in Vietnam initiated in the late 1980s included deregulation of the health system resulting in extensive changes in health care delivery, access, and financing. One aspect of the health sector reform was the introduction of user fees at both public and private health facilities, which was in stark contrast to the former socialized system of free medical care. Subsequently, health insurance and free health care cards for the poor were introduced to mitigate the barriers to seeking care and financial burden imposed by out-of-pocket (OOP) health payments as a result of the user fees. OBJECTIVE To examine the determinants of seeking care and OOP payments as well as the relationship between individual out-of-pocket (OOP) health expenditures and household ability to pay (ATP) during 1992-2002. DATA The data are drawn from 1992-93 and 1997-98 Vietnam Living Standard Surveys (VLSS) and 2002 Vietnam Household and Living Standards Survey (VHLSS). METHODS We use a two-part model where the first part is a probit model that estimates the probability that an individual will seek treatment. The second part is a truncated non-linear regression model that uses ordinary least-squares and fixed effects methods to estimate the determinants of OOP payments that are measured both as absolute as well as relative expenditures. Based on the analysis, we examine the relationship between the predicted shares of individual OOP health payments and households ATP as well as selected socioeconomic characteristics. RESULTS Our results indicate that payments increased with increasing ATP, but the consequent financial burden (payment share) decreased with increasing ATP, indicating a regressive system during the first two periods. However, share of payments increased with ATP, indicating a progressive system by 2002. When comparing across years, we find horizontal inequities in all the years that worsened between 1992 and 1998 but improved by 2002. CONCLUSION The regressivity in payments noted during 1992 and 1998 might be because the rich could avail of health insurance more than those at lower incomes and as a consequence, were able to use the healthcare system more effectively without paying a high OOP payment. In contrast, the poor either incurred higher OOP payments or were discouraged from seeking treatments until their ailment became serious. This inequality becomes exacerbated in 1998 when insurance take-up rates were not high, but the impact of privatization and deregulation was already occurring. By 2002, insurance take-up rates were much higher, and poverty alleviation policies (e.g., free health insurance and health fund membership targeted for the poor) were instituted, which may have resulted in a less regressive system.

Gender Differences in Living Arrangements Among Older Persons in India

The 52nd round of National Sample Survey data was used to explore gender differences in the living arrangements of older persons in India. Data demonstrate that older women, aged 60 and older are more likely to live alone than older men, after controlling for demographics, socioeconomic characteristics, health status, economic independence, and property ownership. Economic independence is a statistically significant determinant of living arrangements for both older men and women. Worse health in terms of physical immobility increases the likelihood of living alone or with spouse only for older men. Results indicate that having sons decreases the likelihood of living alone for older women, particularly if they are immobile. In contrast, immobility has no significant association with living arrangement choice for older men who have no children or only have daughters, and instead significantly increases the likelihood of living alone for older women with only daughters.

Direct and Indirect Effects of a Maternal and Child Health Program in Rural Bangladesh

This study is on the impact evaluation of a maternal and child health program in rural Bangladesh. The program was administered in a treatment area with an equally impoverished area retained as a control area. Using a standard utility maximization framework and data from Matlab Health and Socio-Economic Survey of 1996, treatment effects are estimated without the standard problems of endogenous program placement and selection. Results find not just a strong direct effect on the health of targeted individuals but also a significant spillover effect on the health of some non-targeted individuals. Results indicate that the externality is generated within the household and not through a community effect. Thus, this study raises important issues for the design of public policy programs.

Caring from Afar: Asian H1B Migrant Workers and Aging Parents

With the growth in engineering/technology industries, the United States has seen an increase in the arrival of highly skilled temporary migrant workers on H1B visas from various Asian countries. Limited research exists on how these groups maintain family ties from afar including caring for aging parents. This study explores the experiences and challenges that Asian H1B workers face when providing care from a distance. A total of 21 Chinese/Taiwanese, Korean, and Indian H1B workers participated in in-depth qualitative interviews. Key findings indicate that despite distance, caring relationships still continue through regular communications, financial remittances, and return visits, at the same time creating emotional, psychological, and financial challenges for the workers. Findings highlight the need for further research in understanding how the decline of aging parent’s health impacts the migrants’ adjustment and health in the United States.

Revisiting the Impact of a Reproductive Health Intervention on Children's Height-for-Age with Evidence from Rural Bangladesh

This article evaluates the impact of a reproductive health program on the nutritional status of children under the age of 10 in rural Bangladesh. The program was administered in a treatment area while retaining an equally impoverished area as control through a doorstep delivery, allowing us to estimate treatment effects without problems of endogenous program placement and self‐selected participation. A reduced‐form demand approach has been applied using Matlab Health and Socioeconomic Survey of 1996 data to estimate program effects, returns to mother’s education, the joint effect of the program and household characteristics, as well as gender differences in nutritional outcomes. Results indicate that the program significantly improves the health of boys and girls in the treatment area. Mother’s education has a positive impact on childs health, more so for girls than boys. The program is a substitute for maternal education in improving boys’ health, whereas it is a complement to household wealth in improving girls’ nutritional status.

Sunday Streets SF: An Economic Impact Assessment

Ciclovias, known in the U.S. as Open Streets initiatives, close streets to vehicles to increase open space and recreational opportunities for local communities. In San Francisco, the ciclovia “Sunday Streets” began in 2008 to promote bicycling among residents in neighborhoods underserved for recreational resources and experiencing high disease burden. Initial studies found direct health impacts. In addition, open streets create opportunities for greater economic activity with potential spillover impacts on the health of the urban community. This aspect has been less explored and is the focus of this paper. Direct impacts on the economy of the host community were estimated from data collected using a survey inquiring about revenue, customer activity, and employment. Multiplier effects were then calculated to estimate returns to dollars spent. In most cases there was an increase in economic activity during Sunday Streets including increased revenue, income and employment that demonstrate positive unintended spillovers.

Gender Differences in the Roles of Religious Support and Social Network Support in Reducing Depressive Symptoms Among Older Korean Americans

ABSTRACT This study examined gender differences in the interaction effects of religious support and social network support on depressive symptoms among older Korean Americans. Data were derived from a cross-sectional survey of 85 Korean American women and 115 Korean American men aged 65 years or older living in New York City. A 2-step hierarchical multiple regression analysis revealed that the associations between religious support, social network support, and depressive symptoms were different for older Korean men and women. Among men, social network support was identified as a strong predictor for depressive symptoms. Conversely, religious support was identified as a predictor for depressive symptoms among women. The interaction between social network support and religious support was found to be statistically significant only for women. Additionally, the association of social networks with fewer depressive symptoms was stronger for women with high religious support. Our findings highlight the importance of gender differences in understanding psychological effects of social network support within a religious-cultural context and the need for geriatric practitioners to assess carefully the quality and types of social support systems. Further studies are needed to identify common and gender-specific risk/protective factors among older Korean Americans to develop gender-targeted preventions and interventions to improve their psychological well-being.

Gender Differences in Healthcare Utilization in Later Life

The discourse on gender and health frequently asserts that older women are universally more vulnerable to social, economic and health disadvantages than men. Most societies generally observe a nearly universal pattern of longer life expectancy among women, but in itself longer life conveys relatively little about the quality of life and burden of non-fatal disease during the extended years. Empirical studies from developed countries tend to observe that women report higher rates of morbidity and higher healthcare utilization than men. However, morbidity disadvantage among women diminishes with age; gender differences in self-rated health often vanish or are reversed in old age (Arber and Ginn, 1993). Although there is no similar debate regarding higher mortality rates among males, recent studies indicate that the pattern of gender differences in morbidity and healthcare utilization may be more complex, and they vary by measures of health, by symptoms, and across the life course (Macintyre et al., 1996; see also Chapter 12 by Hunt et al.).

Impact of Sibling Rivalry on the Nutritional Status of Children: Evidence from Matlab, Bangladesh

This paper examines the impact of sibling rivalry for resources on childrens health outcomes by studying the effect of sibling composition and birth order on the height for age of children below ten years. This study determines whether relaxing resource constraints reduces the impact of sibling rivalry. Further, sibling gender effect on the health outcomes for young boys and girls are examined. Results indicate that siblings that face more competition fare worse. Relaxing time, credit and information constraints alleviate sibling rivalry effects for boys. Additional siblings make boys in less landed households worse off but make girls in more landed households worse off suggesting a threshold for sibling rivalry. Boys are not always better off than girls and presence of male siblings can negatively impact boys more than girls.