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Table 5 Gender Barriers in the CMCHIS [Source: Authors]

From: Why is women’s utilization of a publicly funded health insurance low?: a qualitative study in Tamil Nadu, India

Gender Specific

Gender Intensified

Gender Imposed

(Barriers that are closely linked to masculinity and femininity norms, exclusive to each gender)

(Barriers faced by both men and women but intensified for women)

(Gender biases reflected in institutional norms [written or unwritten])

For Women:

 Restricted mobility to participate in community activities and reach healthcare services

Lack of literacy and poor participation in awareness and enrollment activities of scheme

Requirement of female attendants for hospital admissions for women

 Continuous burden of care work (cooking, cleaning, caring for old, young, sick)

Lack of documentary evidence to access scheme benefits

Insurance policies discriminating women who are not wives or mothers or outside mainstream relationships

 Notions of sacrifice and guilt

Age, marital status, class, caste, political inequalities intersect with gender to accentuate barriers

Impact of health insurance measured with household as an egalitarian unit making women’s experiences invisible

Poor perception of one’s own health needs

Poor negotiating skills with persons of authority to claim entitlements


For Men:

Increased mobility resulting in risks of accidents

Cherry picking by providers and induced utilization


 Risk taking and aggression resulting in perpetrating and subject of violence

Poor financial protection from OOPE resulting in delay in hospitalization and distress coping


 Burden of bringing income as head of household

Insurance mechanisms weakening public healthcare institutions