Access to healthcare among the elderly suffering from COVID-19 and catastrophic health expenditure in West Bengal, India
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Indian Institute of Technology Kharagpur, Dr. B. C. Roy Multi-Speciality Medical Research Centre, Room no. 735, Life Science Building, IIT Kharagpur, India
Dr. B. C. Roy Multi-Speciality Medical Research Centre, Indian Institute of Technology Kharagpur, India
Foundation for Actions and Innovations Towards Health Promotion, India
Publication date: 2023-04-26
Popul. Med. 2023;5(Supplement):A1900
Background and Objective:
Access to healthcare among the elderly is an important issue, particularly in low-and middle-income countries like India because of the devastating effect of the COVID-19 pandemic. To curb inequity, home-based care of the elderly through family caregivers is noted to be a cost-effective strategy with need-based institutionalization in the resource constraint settings. Against this backdrop, this study explored the socio-economic inequities in COVID-19-related healthcare access among the elderly and determined the factors associated with catastrophic health expenditure (CHE).

This community-based study recruited age and gender-matched cohorts of elderly (≥ 60 years) first-time COVID-19-positive patients in home-based care (n=1392) or institutional care (n=1412) during the first and second waves of the pandemic in Kolkata, India. During follow-up, information was obtained regarding monthly per capita income (PCI) and monthly out-of-pocket expenditure on health (OOPEH) in view of COVID-19 illness. CHE was considered for OOPEH ≥ 40% of non-food monthly spending. The contribution of different factors in CHE was assessed through generalized linear models.

The majority of the participants were in the median income quantile with an average monthly per capita income (PCI) of Rs. 5040.09 (±182.36) and an average monthly OOPEH of Rs. 4994.39 (±1602.07). Among initially home-isolated and immediately institutionalized patients, respectively, 38.45% and 15.80% had health insurance (HI), while 84.91% and 94.40% of respective families sustained CHE. HI did not have an effect on CHE. Lower PCI was associated with CHE. During the 1st and the 2nd waves, hospital-based care had a relative risk (95% Confidence Interval) of 1.31 (1.20–1.43) and 1.25 (1.20–1.31), respectively, for CHE in the families.

Insurance of health was not a prevalent practice in the case of elderly patients. Income inequity contributed to CHE. Independently, institutional care among the elderly further increased the inequity through a higher risk of CHE.