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Access to healthcare among the elderly suffering from COVID-19 and catastrophic health expenditure in West Bengal, India
1
Indian Institute of Technology Kharagpur, Dr. B. C. Roy Multi-Speciality Medical Research Centre, Room no. 735, Life Science Building, IIT Kharagpur, India
2
Dr. B. C. Roy Multi-Speciality Medical Research Centre, Indian Institute of Technology Kharagpur, India
3
Foundation for Actions and Innovations Towards Health Promotion, India
Publication date: 2023-04-26
Popul. Med. 2023;5(Supplement):A1900
ABSTRACT
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).
Methods:
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.
Results:
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.
Conclusion:
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.
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).
Methods:
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.
Results:
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.
Conclusion:
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.
| ISSN: | 2654-1459 |
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