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Studies on the association between population ageing and health spending are inconclusive. Though per capita health spending has a strong age gradient, evidence from the developed countries attributes increasing health expenditure to high spending in terminal year of life. In India, though studies have examined the level, trends and determinants of health care spending, no attempt has been made on association of population ageing and per capita health spending across the districts of India. The objective of this paper was to examine the spatial dependencies and heterogeneities of population ageing and per capita health spending across 640 districts of India. Data from the Census of India (2011) and the consumption expenditure rounds of the National Sample Survey Organisation (NSSO) (2009–10 and 2011–2012) were used in the analysis. Univariate and bivariate LISA analysis, ordinary least square regression, and spatial error model were used to decipher the spatial pattern of population ageing and health spending in the districts of India. Results suggest that per capita health expenditure is positively associated with the proportion of the older adults (aged 60 years and above) in the districts of India. Districts with less than 5% older adults have an annual per capita health expenditure of ₹629 compared to ₹2432 in districts with older adults 12% or more. Districts of India also exhibit large spatial heterogeneity in household health spending. Bivariate Moran's I statistic of proportion of older adults and per capita annual health expenditure was 0.48, suggesting spatially association of the share of the older adults and the per capita annual health expenditure in India. Results of the spatial error model confirmed that share of urban population, mean wealth score, and mean household size are significant predictors of per capita annual health expenditure in India. This study is important to monitor the progress of universal health coverage across the disadvantaged districts and to integrate age component in universal health coverage programmes. [ABSTRACT FROM AUTHOR]

Indian population is ageing at a higher pace coupled with the increase in life expectancy, and the prevalence of cognitive impairment, dementia, and comorbidities increase dramatically with age. Such cognitive and physical changes are intimately linked with declines in everyday functioning that include loss of decision-making skills. The present study explored the relationship between socioeconomic and health status of older adults and their role in household decision making. The study used data from the "Building a Knowledge Base of Population Ageing in India" (BKPAI) survey conducted in 2011 (n = 9181). Descriptive statistics along with multivariate negative binomial and binary logistic regression analyses were conducted. A proportion of 29.7% of older adults had no or partial involvement in household decision making and 26.5% of older adults reported that they had witnessed a decline in their role as decision-maker. The involvement of older adults in household decision making was 1.51 times lower among those who did not contribute money in household expenditure (incidence rate tatio (IRR):1.51; 95% confidence interval (CI): 1.24, 1.84) than those who contributed. Respondents who had low cognitive ability (IRR: 1.22; 95% CI: 1.09, 1.37) or had more than one disability (IRR: 1.27; 95%CI: 1.09, 1.47) were significantly 1.22 and 1.27 times less likely to have involvement in household decision making, respecctively. Older adults who reported low self-rated health (adjusted odds rati (aOR): 1.4; 95% CI: 1.21, 1.61), low general health (aOR: 2.85; 95% CI: 2.46, 3.31), low subjective wellbeing (aOR: 2.29; 95% CI: 1.99, 2.64) and low IADL (aOR: 1.49; 95% CI: 1.31, 1.69) were significantly more likely to report a decline in the role as a decision maker compared to their healthy counterparts. Along with the poor socioeconomic characteristics, the negative effects of cognitive and health markers of ageing further diminish the role of older adults in household decision making. Further research in the field of familial role and importance of older adults in different family settings is required in tackling a wide range of issues related to the wellbeing of the aged population. [ABSTRACT FROM AUTHOR]