A Theoretical Framework for Analyzing Inequalities in Health Care

Matus-López, Mauricio and Gallego-Morón, Nazareth (2025): A Theoretical Framework for Analyzing Inequalities in Health Care.

Abstract

Gender inequalities affect all aspects of society, including political, economic, and social domains—and health systems are no exception. This paper proposes a concise theoretical framework to analyze the multiple gendered dimensions within health systems, based on the World Health Organization’s classification of core health system functions. By examining financing, governance, resource generation, and service provision, the framework highlights how gender disparities are embedded in institutional structures and practices. Specific evidence from recent studies is included to illustrate these dynamics. Ultimately, the proposed framework aims to serve for the research project on the historical development of public health systems.

• Item Type: MPRA Paper
• Language: English
• Keywords: Gender; Health Care Systems; Disparities; Inequalities; Theoretical Framework
• Subjects: I - Health, Education, and Welfare > I0 - General > I00 - General; I - Health, Education, and Welfare > I1 - Health > I14 - Health and Inequality; I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy ; Regulation ; Public Health; N - Economic History > N0 - General > N00 - General

References

Arrizabalaga, P., Doltra, A., Baranda, L., & Sebastià, M. C. (2024). The iceberg of discrimination based on gender in hospital medicine. Medicina Clínica (Barcelona), 162(7), 343–349. https://doi.org/10.1016/j.medcli.2023.10.024

Australian Government. (2024). EndGenderBias: Survey summary report. Department of Health and Aged Care. https://www.health.gov.au/sites/default/files/2024-03/endgenderbias-survey-results-summary-report_0.pdf

Daher, M., Al Rifai, M., Kherallah, R. Y., Rodriguez, F., Mahtta, D., Michos, E. D., Khan, S. U., Petersen, L. A., & Virani, S. S. (2021). Gender disparities in difficulty accessing healthcare and cost-related medication non-adherence: The CDC behavioral risk factor surveillance system (BRFSS) survey. Preventive Medicine, 153, 106779. https://doi.org/10.1016/j.ypmed.2021.106779

Debbink, M. P., Tuuli, M. G., Geller, A., Salganicoff, A. N., Burke, S. P., & Secord, A. A. (2025). A new way forward for women's health research at the National Institutes of Health: A roadmap from the National Academies of Sciences, Engineering, and Medicine's consensus report. Obstetrics & Gynecology, 145(3), 273–280. https://doi.org/10.1097/AOG.0000000000005841

Kapoor, M., Agrawal, D., Ravi, S., Roy, A., Subramanian, S. V., & Guleria, R. (2019). Missing female patients: An observational analysis of sex ratio among outpatients in a referral tertiary care public hospital in India. BMJ Open, 9(8), e026850. https://doi.org/10.1136/bmjopen-2018-026850

Keene, J., & Li, X. (2005). Age and gender differences in health service utilization. Journal of Public Health (Oxford), 27(1), 74–79. https://doi.org/10.1093/pubmed/fdh208

LaMandre, E. (2025). Medical gaslighting: A silent epidemic in healthcare. The Nurse Practitioner, 50(3), 6. https://doi.org/10.1097/01.NPR.0000000000000292

Matus-López, M. (2023). La pandemia de COVID-19 como oportunidad de cambio: avanzar hacia la salud universal en América Latina (Documentos de Proyectos, LC/TS.2023/22). Comisión Económica para América Latina y el Caribe (CEPAL). https://www.cepal.org/es/publicaciones/48772-la-pandemia-covid-19-como-oportunidad-cambio-avanzar-la-salud-universal-america

Merone, L., Tsey, K., Russell, D., & Nagle, C. (2022). Sex inequalities in medical research: A systematic scoping review of the literature. Women's Health Reports, 3(1), 49–59. https://doi.org/10.1089/whr.2021.0083

Merone, L., Tsey, K., Russell, D., & Nagle, C. (2022). Sex inequalities in medical research: A systematic scoping review of the literature. Women's Health Reports, 3(1), 49–59. https://doi.org/10.1089/whr.2021.0083

Mirin, A. A. (2021). Gender disparity in the funding of diseases by the U.S. National Institutes of Health. Journal of Women's Health, 30(7), 956–963. https://doi.org/10.1089/jwh.2020.8682

Mirin, A. A. (2021). Gender disparity in the funding of diseases by the U.S. National Institutes of Health. Journal of Women's Health, 30(7), 956–963. https://doi.org/10.1089/jwh.2020.8682

Morgan, R., George, A., Ssali, S., Hawkins, K., Molyneux, S., & Theobald, S. (2016). How to do (or not to do)… gender analysis in health systems research. Health Policy and Planning, 31(8), 1069–1078. https://doi.org/10.1093/heapol/czw037

Ng, I. K., Tham, S. Z., Singh, G. D., Thong, C., & Teo, D. B. (2024). Medical gaslighting: A new colloquialism. The American Journal of Medicine, 137(10), 920–922. https://doi.org/10.1016/j.amjmed.2024.06.022

Parslow, R., Jorm, A., Christensen, H., Jacomb, P., & Rodgers, B. (2004). Gender differences in factors affecting use of health services: An analysis of a community study of middle-aged and older Australians. Social Science & Medicine, 59(10), 2121–2129. https://doi.org/10.1016/j.socscimed.2004.03.018

Redondo-Sendino, A., Guallar-Castillón, P., Banegas, J. R., & Rodríguez-Artalejo, F. (2006). Gender differences in the utilization of health-care services among the older adult population of Spain. BMC Public Health, 6, 155. https://doi.org/10.1186/1471-2458-6-155

Redondo-Sendino, A., Guallar-Castillón, P., Banegas, J. R., & Rodríguez-Artalejo, F. (2006). Gender differences in the utilization of health-care services among the older adult population of Spain. BMC Public Health, 6, 155. https://doi.org/10.1186/1471-2458-6-155

Sebring, J. C. H. (2021). Towards a sociological understanding of medical gaslighting in western health care. Sociology of Health & Illness, 43(9), 1951–1964. https://doi.org/10.1111/1467-9566.13367

Sheikh, K., George, A., & Gilson, L. (2014). People-centred science: Strengthening the practice of health policy and systems research. Health Research Policy and Systems, 12, 19. http://www.health-policy-systems.com/content/12/1/19

Vaidya, V., Partha, G., & Karmakar, M. (2012). Gender differences in utilization of preventive care services in the United States. Journal of Women's Health, 21(2), 140–145. https://doi.org/10.1089/jwh.2011.2876

World Health Organization. (2000). The world health report 2000: Health systems—Improving performance. World Health Organization. https://www.who.int/publications/i/item/924156198X