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Health Policy and Planning; 17(3): 264-272
© Oxford University Press 2002

The gender gap in primary health care resource utilization in Central Asia

Cheryl E Cashin1, Michael Borowitz2 and Olga Zuess3

1 Leader, Health Systems Research Group, Department of Tropical Hygiene and Public Health, University of Heidelberg, Germany,
2 Senior Health Advisor for the Former Soviet Union, Department for International Development, London, UK and
3 Health Economist, ZdravPlus Program, Almaty, Kazakhstan

There is a large gender gap in life expectancy in some countries of the former Soviet Union. Life expectancy of males is as much as 13 years less than that of females, and a significant portion of the excess male mortality is caused by cardiovascular disease. Although effective primary health care is necessary to manage cardiovascular disease and reduce acute episodes and mortality, the primary health care system is under-utilized by adult males in the region. This study combines disaggregated utilization data with cost data to analyze patterns of per capita primary care resource consumption in urban and rural regions of Kazakhstan and Uzbekistan. The results show that both in absolute and per capita terms, the principal users of primary health are women of reproductive age and children under five. Based on a combination of utilization and cost of services, women of reproductive age consume approximately 1.5 times the average per capita primary health care resources, while men in the same age group consume approximately one-half of the average. Children under five consume about three to five times the average per capita primary care resources. Based on the results of the study, regional government health purchasers worked together with providers to develop a new per capita payment system with age/sex adjustments and incentives for outreach to bring adult men into the primary care system.


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