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<p>Given India’s low public health expenditure and high out-of-pocket expenditures (OOPE), households often face severe financial burden, often pushing families into poverty. In recent decades, the launch of health insurance has been proposed as one of the vital strategies for financial protection during access to healthcare in India. This study examines the role of different health insurance schemes in providing financial protection among older adults within India’s complex healthcare system. Using national data from the Longitudinal Ageing Study in India (LASI, 2017–2018), the research assesses the coverage and effectiveness of different health insurance schemes including publicly funded health insurance schemes (PFHIs), Central Government Health Scheme (CGHS), Employees’ State Insurance Scheme (ESIS), and privately purchased health insurance schemes. Financial protection was evaluated through catastrophic health expenditure (CHE) and OOPE related to hospitalisation of older adults in India. Results indicate that overall health insurance coverage among India’s older adults (45&#xa0;years and above) remains low (22.9%). Among households reporting hospitalisation, 39.9% experienced CHE10 and 30.1% experienced CHE40, indicating a substantial financial burden despite the presence of insurance schemes. Propensity score matching results showed that PFHIs and private insurance did not have a significant effect on financial protection, whereas CGHS and ESIS had a significant protective effect for households during hospitalisation. Barriers such as lack of awareness and affordability restrict insurance uptake, particularly among rural populations and vulnerable groups. To advance universal health coverage (UHC) and ensure equitable healthcare access, strengthening benefit packages and improving implementation efficiency are essential.</p>

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Health Insurance and Financial Protection Among Older Adults in India: A Comparison of Insurance Schemes

  • 期刊论文

  • 发表日期：

    2026年7月16日

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  • Isha Sharma,
  • Alok Ranjan

摘要

Given India’s low public health expenditure and high out-of-pocket expenditures (OOPE), households often face severe financial burden, often pushing families into poverty. In recent decades, the launch of health insurance has been proposed as one of the vital strategies for financial protection during access to healthcare in India. This study examines the role of different health insurance schemes in providing financial protection among older adults within India’s complex healthcare system. Using national data from the Longitudinal Ageing Study in India (LASI, 2017–2018), the research assesses the coverage and effectiveness of different health insurance schemes including publicly funded health insurance schemes (PFHIs), Central Government Health Scheme (CGHS), Employees’ State Insurance Scheme (ESIS), and privately purchased health insurance schemes. Financial protection was evaluated through catastrophic health expenditure (CHE) and OOPE related to hospitalisation of older adults in India. Results indicate that overall health insurance coverage among India’s older adults (45 years and above) remains low (22.9%). Among households reporting hospitalisation, 39.9% experienced CHE10 and 30.1% experienced CHE40, indicating a substantial financial burden despite the presence of insurance schemes. Propensity score matching results showed that PFHIs and private insurance did not have a significant effect on financial protection, whereas CGHS and ESIS had a significant protective effect for households during hospitalisation. Barriers such as lack of awareness and affordability restrict insurance uptake, particularly among rural populations and vulnerable groups. To advance universal health coverage (UHC) and ensure equitable healthcare access, strengthening benefit packages and improving implementation efficiency are essential.