Catastrophic health spending among older adults in India: Role of multiple deprivation

Background: Previous studies have assessed catastrophic health spending (CHS) is high among households with older member, but no studies have examined its association with multiple deprivation. The purpose of this study is to compare the incidence and determinants of CHS between multiple deprived and non-deprived households in India. Methods: Data for this paper was obtained from the 75th round of the National Sample Survey (NSS), a crosssectional household survey conducted in 2017-18. The multiple deprivation index was estimated using Alkire and Foster method while CHS was estimated using the capacity to pay approach. Logistic regression analysis was used to identify the determinants of CHS in both types of households. Results: The study found 43% of households with an older member were deprived in multiple dimensions. We found the incidence of CHS was 19% among households with an older adults; 22% among multiple deprived and 16% among the multiple non-deprived older adult households. Regression analysis result suggest that the odds ratio of incurring CHS was 1.84 (p < 0.001) for the deprived older adult households than that of non-deprived households. Apart from multiple deprivation, any member being hospitalized or any member suffering from chronic diseases significantly associated with CHS in both type of households. Conclusion: This study established the higher financial catastrophes among the deprived older adult households. Therefore, there is an utmost need for the government and policymakers to focus on multiple aspects of geriatric wellbeing at one hand and improving financial mechanisms to reduce the CHS at other hand.