Nature and determinants of out-of-pocket health expenditure among older people in a rural Indian community

E M Brinda, A. P. Rajkumar, U Enemark, M Prince, K S Jacob

Research output: Contribution to journalArticlepeer-review

47 Citations (Scopus)


Background: Increasing out-of-pocket health expenditure among older people worsens the inequitable access to essential health services in low and middle-income countries (LMIC). We investigated various socioeconomic and health factors associated with out-of-pocket and catastrophic health expenditures among rural older people in India.

Methods: We recruited 1,000 participants aged above 65 years from Kaniyambadi block, Vellore, India. We assessed their out-of-pocket health expenditure, health service utilization, socioeconomic profiles, disability, cognition, and health status by standard instruments. We employed appropriate multivariate statistics evaluating these determinants.

Results: Male gender, poor sanitation, diabetes, tuberculosis, malaria, respiratory ailments, gastrointestinal diseases, dementia, depression, and disability were associated with higher out-of-pocket expenditures. Illiteracy, tuberculosis, diabetes, and dementia increased the risk for catastrophic health expenditures, while pension schemes protected against it. Income inequalities were associated with inequities on education, disease prevalence, and access to safe water, sanitation, and nutrition.

Conclusions: Interactions between determinants of out-of-pocket health expenditure, economic inequality, and inequities on essential health care delivery to older people are complex. We highlight the need for equitable health services and policies, focusing on both medical and social determinants.
Original languageEnglish
Pages (from-to)1664-1673
Number of pages10
JournalInternational Psychogeriatrics
Issue number10
Early online date22 May 2012
Publication statusPublished - Oct 2012


Dive into the research topics of 'Nature and determinants of out-of-pocket health expenditure among older people in a rural Indian community'. Together they form a unique fingerprint.

Cite this