Government Sponsored Health Insurance Coverage and Out-of-pocket Spending Among Elderly in Kerala: A Cross-sectional Study - Government Sponsored Health Insurance Coverage and Out-of-pocket Spending Among Elderly in Kerala: A Cross-sectional Study - Open Access Pub

We aimed to find the population coverage, health service utilization and out-of-pocket spending among the elderly who are insured under Comprehensive Health Insurance Scheme (CHIS), Kerala through a longitudinal study of 600 non-rich households for nine months. The study found that only 57.7% the elderly were insured under CHIS which is lower than the population average of 80%. Single elderly from a socially backward caste, living alone in kutcha or semi-pucca houses were excluded from CHIS. Even though insured elderly had more episodes of hospitalization, only 38.4% of the elderly could make use of CHIS smart card for payment during hospitalization and 43.6% of the episodes were covered by CHIS. The mean indirect out-of-pocket expenses among insured elderly who had used smart cards for hospitalization (INR 7679.25) was higher than that for the un-insured (INR 4455.26), p = 0.027. The mean monthly drug expenditure (INR 1105.09) was also significantly higher among the insured as compared to the un-insured elderly (INR 650.03), p=.004. More than 80% of the hospitalized households had to use distress finance mechanisms to meet health- related expenses. We found that population coverage among elderly did not translate into service coverage and thus financial risk protection was not achieved even in a state like Kerala which is considered to be well-performing in terms of health insurance coverage. This study points out that elderly being a vulnerable group with special needs require a more comprehensive service package including chronic disease care, and a higher level of financial coverage. DOI10.14302/issn.2474-7785.jarh-17-1489 The proportion of elderly in the population has been increasing in societies around the world, including in many low and middle income countries as a result of demographic transition. The size and the growth rate of the elderly population vary across regions, countries and within countries. 1, 2 We can notice an advanced demographic transition in India in the recent years which has caused serious social and economic consequences. 3 According to Census 2011 the proportion of elderly (60+) population in India is 8%4 with the third largest number of elderly in the world.5, 6 Even though the proportion is low, the absolute number of elderly pause a serious concern in terms of health-care costs, higher pension costs, and a decreasing proportion of workforce and increased dependency. The state of Kerala in India is in the most advanced stage of demographic and epidemiological transition.3, 4, 7, 8, 9 Kerala has below replacement level