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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