OBJECTIVES: India has an increasing number of elderly people. Burden of out-of-pocket health expenditures (OOPHE) in India have been continuously increasing. This research analyzes the Horizontal Inequities in OOPHE and Catastrophic Health Expenditure (CHE) incurred during the outpatient and inpatient care among older adults in India.

METHODS: National Sample Survey 75^th Round (2017-2018) is used for the analysis. OOPE on both outpatient and inpatient treatment for older adults was estimated for following ailments: a) non-communicable diseases (NCDs) b) Infections c) Injuries and d) HIV/Sexually Transmitted Diseases. Further, the CHE will be ascertained by the measure of Overshoot and Mean Positive Overshoot Indices for all the categories of ailments. To investigate the income-based inequities, the Concentration curves and Concentration indices was computed for OOPHE and CHE. A robust and modified measure of Erreyger’s corrected indices was used to compute the Need Standardized Horizontal Inequities in CHE. The progressivity of the Healthcare Payments was estimated using the Kakwani Index.

RESULTS: Proportion of elderly experiencing CHE in India is around 24.03% and the mean positive overshoot is 22.3%. Higher degree of inequality in experiencing CHE is among the elderly belonging to poorer households, and elderly from households with lower level of education. NCDs contribute to the major cause of experiencing CHE for inpatient healthcare expenditures, followed by infections, injuries and HIV/sexually transmitted diseases. Infections constitute the major cause of experiencing CHE for ambulatory healthcare expenditures.

CONCLUSIONS: Identifying the various determinants of the OOPHE and CHE among elderly in India will help the government to establish policies and direct public health actions to protect the elderly from experiencing burden due to OOPHE and CHE and also to reduce horizontal inequities in experiencing healthcare expenditures both for the ambulatory and inpatient healthcare.