Health status and health financing among geriatric population in Kerala

Abstract

Population ageing is a growing phenomenon worldwide. The geriatric population, generally defined as individuals aged 60 years and above in the Indian context, represents a demographic group with distinctive health needs and vulnerabilities. Kerala, with one of the highest proportions of elderly in India, faces unique challenges in ensuring adequate health care access and financial protection for this age group. Against this backdrop, the present study investigates the health status, health care financing, and demand for health care among the elderly in Kerala, using the Minimum Standard approach popularised by the World Health Organization as its conceptual framework. This study adopts a mixed-method approach, using both primary and secondary data. Primary data were collected directly from elderly individuals across diverse districts of Kerala to capture variations in demographic, socioeconomic, and health-related characteristics. Secondary data were sourced from established databases and surveys, including the Building a Knowledge Base on Population Ageing in India (BKPAI) survey, the Longitudinal Ageing Study in India (LASJ), and the Kerala Ageing Survey (KAS). This combination of data sources enabled a comprehensive analysis of health conditions, patterns of healthcare utilisation, financial burdens, and coping mechanisms. The findings reveal a complex picture of elderly health in Kerala. Patterns of physical activity vary considerably between rural and urban areas, reflecting lifestyle differences rather than a simple absence of exercise. While many elderly individuals report no unhealthy habits, chronic illnesses—particularly hypertension, diabetes, and high cholesterol—are highly prevalent, outweighing acute ailments in frequency. Selfrated health assessments are generally positive, yet a substantial proportion live with diagnosed health conditions. Akey contribution of the study lies in identifying the major determinants of healthcare demand. Among the various socio-demographic factors examined, location (rural versus urban residence) and educational attainment (particularly higher secondary and degree-level education) emerged as statistically significant. These variables influence not only the propensity to seek care but also the type and frequency of services accessed. This suggests that physical proximity to facilities, health awareness, and information access play central roles in shaping healthcare demand among the elderly. From a financing perspective, the study highlights a high reliance on out-of-pocket (OOP) expenditure, with medicines constituting the largest share of household spending on health. The use of private health care facilities, the presence of chronic diseases, and the number of elderly in a household are important predictors of higher OOP costs. A considerable proportion of households face catastrophic health payments, particularly at lower expenditure thresholds, underscoring the inadequacy of financial protection mechanisms. Health insurance coverage among the elderly is moderately widespread, with a combination of public and private schemes in operation. The Rashtriya Swasthya Bima Yojana (RSBY) covers a significant proportion of the elderly, while employerlinked schemes remain rare. Private health insurance is increasingly adopted by middle- and higher-income households. Nevertheless, insurance and social security benefits cover only a fraction of actual costs, leading many elderly to rely on personal income and savings to meet health expenses. Overall, the study underscores the interlinked nature of health status, demand for health care, and financing arrangements within Kerala’s ageing population. The evidence points to an-urgent need for policy interventions aimed at strengthening preventive health measures, improving health literacy, enhancing financial protection through expanded and effective insurance coverage, and ensuring equitable service delivery across both rural and urban areas. By recognising location and education as pivotal determinants, strategies can be more effectively targeted to bridge disparities and promote healthy ageing in the state.