{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T05:50:00Z","timestamp":1791352200933,"version":"4.3.1"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>According to the World Bank\u2019s poverty and inequality platform, 11.09% of India\u2019s population lived below the international poverty line of $2.15 (2017 PPP) per day in 2018. Moreover, 48.2% of total health expenditure is financed through out-of-pocket payments (OOPHE), underscoring their role in driving households into poverty. With 31.4% of households reporting at least one older adult (census 2011), this study focuses on the impoverishing effects of OOPHE among older adults-inclusive households. Using nationally representative data from the NSS 75th round: household social consumption \u2013 health (2017\u20132018), we estimate the poverty headcount and poverty gap at the household level, before and after accounting for OOPHE for households with at least one older adult member. We further employ a binary logistic regression to identify socio-economic and demographic determinants of post-OOPHE impoverishment. The results show that longer hospitalization spells, larger household size, caste status, and reliance on private healthcare significantly elevate the risk of falling into poverty. In contrast, health insurance coverage and higher educational attainment reduce this risk. Despite multiple public schemes and insurance initiatives, coverage remains inadequate and uneven, leaving a substantial share of older adults financially unprotected. These findings point to an urgent need to expand and strengthen publicly financed health insurance and financial risk protection, with targeted safeguards for households with older adults, to prevent healthcare costs from exacerbating poverty.<\/jats:p>","DOI":"10.3389\/fpubh.2026.1950585","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:50:40Z","timestamp":1791348640000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The hidden cost of ageing: measuring the impact of health expenditure on poverty among households with older adults in India"],"prefix":"10.3389","volume":"14","author":[{"given":"Neeraj","family":"Soni","sequence":"first","affiliation":[{"name":"Department of Economic Affairs, Government of India","place":["New Delhi, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajabhushan Jagadish","family":"Nayak","sequence":"additional","affiliation":[{"name":"Sri Sathya Sai Institute of Higher Learning (Deemed to be University)","place":["Puttaparthi, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghna","family":"Ghosh","sequence":"additional","affiliation":[{"name":"BITS Law School","place":["Kalyan, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish","family":"Singh","sequence":"additional","affiliation":[{"name":"Shailesh J. Mehta School of Management","place":["Mumbai, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"ref1","first-page":"65","article-title":"The impoverishing effect of healthcare payments in India: new methodology and findings","volume":"45","author":"Berman","year":"2010","journal-title":"Econ Polit Wkly"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"772","DOI":"10.1186\/s12877-026-07493-9","article-title":"Financial impact of non-communicable diseases on households with older adults in india: a mixed methods study","volume":"26","author":"Prince","year":"2026","journal-title":"BMC Geriatr"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1762886","DOI":"10.3389\/fpubh.2026.1762886","article-title":"Impact of out-of-pocket health expenditure on poverty in India","volume":"14","author":"Soni","year":"2026","journal-title":"Front Public Health"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"7120","DOI":"10.4103\/jfmpc.jfmpc_590_22","article-title":"Impoverishing effects of out-of-pocket healthcare expenditures in India","volume":"11","author":"Sriram","year":"2022","journal-title":"J Family Med Prim Care"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"2278","DOI":"10.4103\/jfmpc.jfmpc_302_19","article-title":"Household out-of-pocket expenditure on health care\u2014a cross-sectional study among urban and rural households, Puducherry","volume":"8","author":"Vasudevan","year":"2019","journal-title":"J Family Med Prim Care"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"15908","DOI":"10.1038\/s41598-024-55142-1","article-title":"Incidence and intensity of catastrophic health expenditure and impoverishment among the elderly: an empirical evidence from India","volume":"14","author":"Ahmad","year":"2024","journal-title":"Sci Rep"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e0135051","DOI":"10.1371\/journal.pone.0135051","article-title":"Socio-economic differentials in impoverishment effects of out-of-pocket health expenditure in China and India: evidence from WHO SAGE","volume":"10","author":"Kumar","year":"2015","journal-title":"PLoS One"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"27","DOI":"10.4337\/9781035362813.00010","article-title":"Migration, unemployment and development: a two-sector analysis","volume":"60","author":"Harris","year":"1970","journal-title":"Am Econ Rev"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"951124","DOI":"10.3389\/fpubh.2022.951124","article-title":"The impact of adult children rural\u2013urban migration on left-behind parents' health: evidence from China","volume":"10","author":"Zhang","year":"2022","journal-title":"Front Public Health"},{"key":"ref10","volume-title":"What Do We Know about Poverty in India in 2017\/18? 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