Healthcare burden and impoverishment among older adults with palliative care needs in India: findings from a...

Out-of-pocket health expenditure (OOPE) is a significant public health concern in India, with an estimated 55 million individuals pushed into poverty due to healthcare expenses. Evidence on the burden and patterns of OOPE among older adults requiring palliative care, and the financial strain faced by them, is limited.

Data from the Longitudinal Ageing Study in India (LASI) identified 2903 older adults aged 60 years and more with palliative care needs using the Supportive and Palliative Care Indicator Tool for Low-Income Settings (SPICT-LIS). Annual healthcare expenditure and OOPE were estimated separately for outpatient care and hospitalisation. At the household level, OOPE and Catastrophic Healthcare Expenditure (CHE) were calculated for the last month. CHE prevalence was mapped across India's states. The Kruskal-Wallis test and Multivariate logistic regression were used to assess differences in mean expenditure and identify household factors associated with CHE, respectively.

The mean annual health expenditure for older adults with palliative care needs was ₹5002 for outpatient care and ₹36,263 for hospitalisation. OOPE accounted for 94% of outpatient and 82% of hospitalisation costs. Significant hospitalisation costs were associated with cancers (₹267,797), heart diseases (₹93,003), and stroke/neurological illnesses (₹54,913). Distress financing methods, such as liquidating savings (24.4%) and taking loans (26.5%), were standard. Nearly one-third of household health spending was attributed to older adults in need of palliative care, with 21.6% of these households facing CHE.

The healthcare needs of older adults requiring palliative care are predominantly funded out of pocket. One in five households with older adults needing palliative care faces catastrophic healthcare expenses, highlighting the need for expanded palliative care programs and health insurance to alleviate economic hardships.