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Using unit cost data from the Longitudinal Ageing Study in India (LASI), 2017–2018, we estimate the total cost among older adults aged 45 years or above on one episode of hospitalization or outpatient visit. These estimates were compared across socioeconomic groups and geographical states and union territories. To facilitate effective comparison, the medical costs have been standardized for differences in age-sex structure, the reason for healthcare use, and the type of facility visited – by extending the common demographic standardization technique. Adjusted costs were calculated using generalized linear regression (gamma) with a log link function. Population-level annual costs for hospitalization were calculated using a two-part model, again with adjustments for age-sex structure across states. Results indicate that costs for hospitalization and OPD are relatively higher in northeast India and hilly states such as Himachal Pradesh, Uttarakhand, and Jammu Kashmir. Hospitalization costs are relatively lower in central states such as Chhattisgarh, and Madhya Pradesh, and OPD costs are relatively lower in western states of India, such as Gujarat and Rajasthan. The difference in healthcare costs is highest between public and private facilities for both hospitalizations and OPD visits. Irrespective of magnitude of differences across socioeconomic categories, cost disparity by caste has highest variation across states and lowest by poverty status for hospitalisation and gender for outpatient service use. Population-level annual cost of hospitalization was relatively higher in southern states, for hospitalisation. Policy (mis) administration in states with relatively lower (or higher) costs should be explored to understand the geographical gradient in adjusted medical costs. Besides, to converge costs and its socioeconomic difference across states, one can consider improvements to the accessibility of affordable healthcare in difficult terrains, reductions in delayed healthcare seeking, and raised health insurance coverage.

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Socioeconomic and Geographic Patterns of Cost for Latest Hospitalization and Outpatient Service Use Among Older Adults Aged 45 Years and Over in India

  • 工具书词条

  • 发表日期：

    2025年

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  • Mayanka Ambade,
  • Rockli Kim,
  • S. V. Subramanian

摘要

Using unit cost data from the Longitudinal Ageing Study in India (LASI), 2017–2018, we estimate the total cost among older adults aged 45 years or above on one episode of hospitalization or outpatient visit. These estimates were compared across socioeconomic groups and geographical states and union territories. To facilitate effective comparison, the medical costs have been standardized for differences in age-sex structure, the reason for healthcare use, and the type of facility visited – by extending the common demographic standardization technique. Adjusted costs were calculated using generalized linear regression (gamma) with a log link function. Population-level annual costs for hospitalization were calculated using a two-part model, again with adjustments for age-sex structure across states. Results indicate that costs for hospitalization and OPD are relatively higher in northeast India and hilly states such as Himachal Pradesh, Uttarakhand, and Jammu Kashmir. Hospitalization costs are relatively lower in central states such as Chhattisgarh, and Madhya Pradesh, and OPD costs are relatively lower in western states of India, such as Gujarat and Rajasthan. The difference in healthcare costs is highest between public and private facilities for both hospitalizations and OPD visits. Irrespective of magnitude of differences across socioeconomic categories, cost disparity by caste has highest variation across states and lowest by poverty status for hospitalisation and gender for outpatient service use. Population-level annual cost of hospitalization was relatively higher in southern states, for hospitalisation. Policy (mis) administration in states with relatively lower (or higher) costs should be explored to understand the geographical gradient in adjusted medical costs. Besides, to converge costs and its socioeconomic difference across states, one can consider improvements to the accessibility of affordable healthcare in difficult terrains, reductions in delayed healthcare seeking, and raised health insurance coverage.