Old‐age dependency and catastrophic health expenditure: Evidence from Longitudinal Ageing Study in India

Abstract

Background Out‐of‐pocket (OOP) payments and catastrophic health expenditure (CHE) have a strong age gradient. Though studies have examined the socio‐demographic and geographic inequality in OOP payments and CHE in India, the role of old‐age dependency in financial catastrophe remains unclear. Disaggregated estimates of CHE by the level of old‐age dependency of households may help identify the most vulnerable sub‐group and provide evidence for specific policies for the financial protection and health care of the elderly. The present study aims to estimate the incidence and intensity of CHE by the old‐age dependency of households among middle‐aged adults and the elderly in India. Methods A total of 42,949 households from the Longitudinal Aging Study in India (LASI), 2017–18, covering households with at least one‐member aged 45+ years, were included in the analysis. Households were classified into three mutually exclusive groups: no old‐age dependency, low old‐age dependency, and high old‐age dependency. The incidence and intensity of CHE were estimated using the capacity‐to‐pay (CTP) approach. Concentration indices and concentration curves examine the extent of socioeconomic inequality in CHE. Binary logistic regression helps to understand the potential predictors of CHE across each type of old‐age‐dependent household. Results We estimated the overall incidence of CHE at 24.6% (95% CI: 23.3–25.8) among middle‐aged adults and the elderly in India. The incidence was 33.2% (95% CI: 31.4–35.1) among households with high old‐age dependency, 23.1% (95% CI: 20.8–25.5) among those with low old‐age dependency, and 20.4% (95% CI: 19.0–21.7) among no old‐age dependency households. CHE intensity was highest among households with low old‐age dependency compared to those no old‐age dependents. Catastrophic health expenditure was higher among the poorer households in each type of old‐age dependency. Among all households, the odds of incurring CHE were higher among households with high old‐age dependency (AOR: 1.52; 95% CI: 1.36–1.69) than those with no old‐age dependency. Lower‐income households, households with pensions as the main source of income, households belonging to scheduled castes, and households residing in rural areas had higher odds of incurring CHE. The co‐variates of CHE varied significantly across the type of old‐age dependency households. A household's enrolment into a health insurance scheme did not necessarily lower its CHE. Conclusion Households with high old‐age dependency had a higher probability of incurring CHE in India. Providing preventive and curative geriatric care in primary health centres (PHC) is recommended.

Understanding variation in catastrophic health expenditure from socio-ecological aspect: a systematic review

“…A study from Malawi and Nigeria concluded that the better off face higher CHE than people with low incomes [ 5 , 29 ]. On the other hand, studies from India and Bangladesh concluded that the poor face higher CHE than the rich [ 21 , 30 , 31 ]. Economic status highly dictates the care utilization pattern, but this variable also gave an assorted result.…”

“…A study from Bangladesh also concluded that people from lower income quintiles have lower CHE as the utilization of formal care is low [ 31 ]. Conversely, poverty consistently predicts CHE, indicating that poor people have higher CHE [ 13 , 18 , 21 , 27 , 28 , 37 , 46 , 48 , 54 , 58 ]. To safeguard poor people from financial catastrophe, several studies from China, Kenya, and Malaysia emphasized on health insurance [ 19 , 20 , 36 , 54 ].…”

“…With age, susceptibility to disease increases [10,19]. Old age dependency makes the situation difficult for senior citizens, especially where the social safety nets are unavailable or poor [20,21]. The patient's gender is another deciding factor in accessing health care and significantly impacts CHE [3,[22][23][24][25][26].…”

Hospital admissions and the financial cost incurred by the elderly patients at a tertiary care centre in Gokarneshwor Municipality, Kathmandu, Nepal

“…19 Similarly, from a study carried out in 42,949 households from Longitudinal Aging Study in India (LASI), it was concluded that households with high old-age dependency had a higher probability of incurring catastrophic health expenditure. 20 However all of these studies have used the health expenditure in excess to 40% of income after subsistence needs fulfilled as the criteria for catastrophic household expenditure. 10 In this study for 95% of the total elderly admissions the duration of hospital stay did not exceed 10 days.…”

Third Agers in India: Empirical Evidence From Longitudinal Aging Study in India (LASI), 2017–2018

“…We take advantage of the recently released Longitudinal Study of Aging in India (LASI Wave 1, 2017Wave 1, -2018 to offer an empirical portrait of Third Agers in India. Considering that the aging scholarship in India has often articulated in the empirical language of dependency, care regimes, and (economic) insecurity (Bloom et al, 2010;Mohanty et al, 2022), we believe this examination allows us to shift the gerontological gaze from a risk perspective to one that is positive and affirmative. We do this by being fully aware of the cultural critique of responsibilization and purported autonomy of older citizens under neoliberal governance.…”