Sex differences in disease burden, utilization, and expenditure on primary health care services in Kerala, India

Sex and gender are important determinants of health, conditioning health exposures and needs, health seeking behavior, health outcomes, and subsequent consequences. We aim to explore the nature and magnitude of sex differences in disease burden, service awareness, utilization, expenditure and satisfaction while accessing primary health care services in the light of recent primary care reforms implemented in the southern Indian state of Kerala. We conducted a cross-sectional study to explore the nature and magnitude of sex differences in disease burden, service awareness, utilization, expenditure and satisfaction in the public sector of Kerala, India. A household survey using multistage random sampling design was conducted to collect information from 3234 households in the selected eight PHC catchment areas of four districts in the state. Descriptive data analysis was carried out with a focus on disease burdens, place of care seeking, cost of care and patient satisfaction, using STATA 12. More males reported fever as their primary ailment compared to females (67.7% vs. 58.6%). A greater proportion of males as compared to females knew about the recently implemented reforms (43% vs 36%; p = 0.01). Allopathic (modern medicine) care was the most sought-after system of medicine across the sample. A higher proportion of females visited government primary health centres for outpatient care (34.7% vs. 27.5%; p = 0.00).Our analysis found statistically significant differences in the self reported cost of care in the private sector: 20 times greater than in public sector for males, whereas the difference was roughly five fold among females (Private: ₹650, $8.5 (95% CI ₹524, ₹776) vs. Public: ₹120, $1.58 (95%CI ₹17, ₹223, p < 0.001)). Males showed greater awareness of state health reforms than females, and high patient satisfaction existed for both private and public outpatient care across sex groups. We found significant sex differences in health system utilization and expenditure in Kerala, although our present analysis lacks data on trans, intersex and other sexual and gender minority groups. Further research on intersectionalities, such as care-seeking experiences across genders and socioeconomic groups, could enhance our understanding the role of sex in care seeking.