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

Published online by Cambridge University Press:  22 May 2012

E. M. Brinda ,
A. P. Rajkumar ,
U. Enemark ,
M. Prince  and
K. S. Jacob
E. M. Brinda
Affiliation:
Department of Psychiatry, Christian Medical College, Vellore, India Department of Health Services Research, Aarhus University, Aarhus, Denmark
A. P. Rajkumar
Affiliation:
Department of Psychiatry, Christian Medical College, Vellore, India Center for Psychiatric Research, Aarhus University Hospital, Risskov, Denmark
U. Enemark
Affiliation:
Department of Health Services Research, Aarhus University, Aarhus, Denmark
M. Prince
Affiliation:
Department of Health Service and Population Research, Institute of Psychiatry, London, UK
K. S. Jacob*
Affiliation:
Department of Psychiatry, Christian Medical College, Vellore, India
*
Correspondence should be addressed to: K. S. Jacob, Professor of Psychiatry, Department of Psychiatry, Christian Medical College, Vellore 632002, Tamil Nadu, India. Phone: +91-416-228-4513; Fax: +91-416-226-2268. Email: ksjacob@cmcvellore.ac.in.
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Abstract

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.

Keywords

health expenditurechronic illnesssocioeconomic factorsrural community
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 10 , October 2012 , pp. 1664 - 1673
Copyright
Copyright © International Psychogeriatric Association 2012

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