The gender gap in primary health care resource utilization in Central Asia.
There is a large gender gap in life expectancy in some countries of the former Soviet Union. Life expectancy of males is as much as 13 years less than that of females, and a significant portion of the excess male mortality is caused by cardiovascular disease. Although effective primary health care is necessary to manage cardiovascular disease and reduce acute episodes and mortality, the primary health care system is under-utilized by adult males in the region. This study combines disaggregated utilization data with cost data to analyze patterns of per capita primary care resource consumption in urban and rural regions of Kazakhstan and Uzbekistan. The results show that both in absolute and per capita terms, the principal users of primary health are women of reproductive age and children under five. Based on a combination of utilization and cost of services, women of reproductive age consume approximately 1.5 times the average per capita primary health care resources, while men in the same age group consume approximately one-half of the average. Children under five consume about three to five times the average per capita primary care resources. Based on the results of the study, regional government health purchasers worked together with providers to develop a new per capita payment system with age/sex adjustments and incentives for outreach to bring adult men into the primary care system.
Health Systems Research Group, Department of Tropical Hygiene and Public Health, University of Heidelberg, Germany. cheryl.cashin@urz.uni-heidelberg.de
Cheryl E
CE
Cashin
Michael
M
Borowitz
Olga
O
Zuess
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001209:Asia, Central / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D015276:Health Care Rationing / Q000379:methods*; D019538:Health Care Surveys; D006801:Humans; D007623:Kazakhstan / Q000453:epidemiology; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D017678:Sex Distribution; D014610:Uzbekistan / Q000453:epidemiology