Sex differences in disease burden, utilization, and expenditure on Primary Health Care Services: Findings from a baseline study in Kerala, India

Abstract We conducted a cross-sectional study 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 light of recent primary care reforms implemented in Kerala. 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 care was the most sought-after system of medicine by both sexes. A higher proportion of females visited government primary health centres for outpatient care (34.7% vs. 27.5%; p = 0.00). The self reported cost of care in the private sector was 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)). Our population-based study found no sex- differences in non-hospitalized disease burden. Males showed greater awareness of state health reforms, and high patient satisfaction existed in both private and public OP care. Research on intersectionalities, such as care-seeking experiences across genders and socioeconomic groups, could enhance our understanding of sex's role in care seeking. Sex differences in disease burden, utilization, and expenditure of Primary Health Care services: Findings from a baseline study in Kerala, India