Who Spends More on Health Expenditures among Elderly? Men or Women?


Women face various health problems during their lives. This has an impact on health costs that must be paid. Gender bias tends to place women in subordinate positions, so they have limited power in making a decision. This study aimed to examine whether gender is a factor impacting health expenditures among the elderly. A cross-sectional study based on the Indonesian Family Life Survey (IFLS) wave 5 included all elderly who accessed self-medication and health services in health facilities during the past 12 months (n=6773). Data regarding outpatient, inpatient, and self-medication costs was obtained from section RJ, RN, and PS from book 3B IFLS wave 5. The health costs that come out of the personal pocket resulted from the total cost of treatment that paid for self-medication, outpatient, and inpatient. Independent T-Test was performed to analyze the difference in health expenditure between elderly males and females. This study found that the average health expenditure was higher among elderly males (IDR 471,011; SD 7,103,932.7) than females (IDR 296,969.9; SD 2,552,816.4), but it was not statistically significant (p=0.195). Based on the type of health expenditure, there was no significant difference in self-medication spending between elderly males and females, as well as in outpatient and inpatient expenditures (p>0.05). Nevertheless, elderly males tended to spend more money on self-medication, outpatient, and inpatient services than females. It concluded that health expenditures between elderly males and females were almost the same. Gender equality in health care was addressed to establish universal health coverage.

Keywords: gender, health expenditure, IFLS, elderly, out-of-pocket

[1] World Health Organization. (2018). Ageing and Health. Retrieved from https://www.who.int/news-room/ fact-sheets/detail/ageing-and-health.

[2] Pusat Data dan Informasi Kementerian Kesehatan Republik Indonesia. (2017). Analisis Lansia Di Indonesia. Jakarta: Pusat Data dan Informasi Kementerian Kesehatan Republik Indonesia.

[3] World Health Organization. (2011). Global Health and Aging (NIH publication no. 11-7737). World Health Organization: Geneva.

[4] Badan Pusat Statistik. (2017). Statistik Penduduk Lanjut Usia 2017. Jakarta: Badan Pusat Statistik.

[5] Saikia, N., & Bora, J. K. (2016). Gender difference in health-care expenditure: evidence from India human development survey. PloS one, 11(7), 1-5.

[6] Kaneda, T., Zimmer, Z., Fang, X., & Tang, Z. (2009). Gender differences in functional health and mortality among the Chinese elderly: testing an exposure versus vulnerability hypothesis. Research on aging, 31(3), 361-388.

[7] Fikree, F. F., & Pasha, O. (2004). Role of gender in health disparity: the South Asian context. BMJ, 328(7443), 823-826.

[8] Ma, C., Jiang, Y., Li, Y., Zhang, Y., Wang, X., Ma, S., & Wang, Y. (2019). Medical expenditure for middle-aged and elderly in Beijing. BMC health services research, 19(1), 360.

[9] Ma, Y., Zhang, L., & Chen, Q. (2012). China’s new cooperative medical scheme for rural residents: popularity of broad coverage poses challenges for costs. Health Affairs, 31(5), 1058-1064.

[10] Li, Y., Wu, Q., Xu, L., Legge, D., Hao, Y., Gao, L., ... & Wan, G. (2012). Factors affecting catastrophic health expenditure and impoverishment from medical expenses in China: policy implications of universal health insurance. Bulletin of the World Health Organization, 90(1), 664-671.

[11] Fang K, Shia B, Ma S (2012) Health Insurance Coverage and Impact: A Survey in Three Cities in China. PLoS ONE 7(6): e39157.

[12] Maharana, B., & Ladusingh, L. (2014). Gender disparity in health and food expenditure in India among elderly. International Journal of Population Research, 2014.

[13] Batra, A., Gupta, I., & Mukhopadhyay, A. (2014). Does discrimination drive gender differences in health expenditure on adults: evidence from Cancer patients in rural India. Indian Statistical Institute, New Delhi, India.

[14] Strauss, J., Witoelar, F., Sikoki, B., & Wattie, A. M. (2016). User’s guide for the Indonesia family life survey. Wave 5. Working Paper WR-1143/2-NIA/NICHD: RAND.

[15] Pradhan, J., Dwivedi, R., & Banjare, P. (2017). Relying on whom? correlates of out of pocket health expenditure among the rural elderly in Odisha, India. Ageing International, 42(3), 306-323.

[16] Rout, H. S. (2006). Gender inequality in household health expenditure: the case of urban Orissa. Nagarlok, 38(3), 44-48.

[17] Hazra, N. C., Rudisill, C., & Gulliford, M. C. (2018). Determinants of health care costs in the senior elderly: age, comorbidity, impairment, or proximity to death?. The European Journal of Health Economics, 19(6), 831-842.

[18] Acharya, S., Ghimire, S., Jeffers, E. M., & Shrestha, N. (2019). Health care utilization and health care expenditure of Nepali older adults. Frontiers in public health, 7 (24), 1-10.