Who Pays More? Gender Gaps in Mental Health Treatment Costs in India

Background Out-of-pocket expenditure (OOPE) on mental health care in India limits progress toward universal health coverage. Detailed analysis of gender-related differences in mental health spending is needed to inform allocation of resources. However, gender-specific patterns in OOPE for mental health have not been adequately studied in existing research. Methods This study used cross-sectional data from the 76th round of the National Sample Survey (NSS) on “Persons with Disabilities in India” to measure gender differences in out-of-pocket expenditure (OOPE) for mental health treatment. The Blinder-Oaxaca decomposition method was applied to estimate the gender gap in OOPE and to quantify the contribution of associated factors, grouped into individual, household, and community-level characteristics. Results On average, males incur 25.4% higher out-of-pocket expenditure (OOPE) for mental health care, while females report higher healthcare burden in specific states and socio-economic groups. Catastrophic health expenditure (CHE) is more frequent among older adults, rural residents, and economically disadvantaged males. Blinder-Oaxaca decomposition attributes 40.2% of the gender gap in OOPE to differences in observed characteristics, with education (76%) and region of residence (29%) being the largest contributors. Individual-level factors, including age, education, and marital status, account for 71.7% of the total explained variation. Conclusion This study shows male-female differences in the financial burden of mental illness treatment in India, with most of the variation explained by individual and community-level factors. The results highlight the need for policy measures that reduce out-of-pocket spending and improve economic support related to mental health care. Improving social protection and economic security may help reduce gender-based differences in access and outcomes.