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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]

Household age-sex composition in India is changing fast due to persistently declining fertility and improvement in life expectancy, rural–urban migration and change in family orientation. Under such circumstances healthcare of older adults is expected to be affected as they mostly depend on other household members. Keeping this in view the present study attempts to answer the question 'How does the change in household age-sex composition affect out of pocket healthcare expenditure of older adults in India?'. Household age-sex composition and healthcare expenditure for rounds of National Sample Survey Organaization (NSSO) conducted in 1993, 1999–00 and 2007–08 are used for the study. Considerable shift in the share of older adults over period of time is noticed and the change in household age-sex composition is found to have significant effect on healthcare expenditure of older adults. More specifically the share of consumption by older adults above 60 years has increased substantially over time with the increase in their composition. The study provides empirical evidence to support the need for public policies to respond to the growing challenges of the changing age structure of India's population. [ABSTRACT FROM AUTHOR]

The psychosocial model of social exclusion postulates that age identity of older persons induce and sustain perceived and enacted discrimination, resulting in psychosocial disability and social exclusion. These propositions were tested by using a cross-sectional survey of 573 older persons, aged 65 years and above. The variables were measured by standardized rating scales. The results reveal age identity significantly influenced perceived (β =.762; p <.001), enacted discrimination (β =.514; p <.001), psychosocial disability (β =.588; p <.001) and social exclusion (β =.389; p <.001). Perceived discrimination significantly increased enacted discrimination (β =.314; p <.001) and enacted discrimination influenced psychosocial disability (β =.279; p <.001) and psychosocial disability increased social exclusion (β =.090; p <.05). Perceived discrimination significantly mediated the negative effect of age identity on enacted discrimination (b =.211; p <.001), psychosocial disability (b =.219; p <.001) and social exclusion (b =.073; p <.05). The conceptual model showed good data model-fit, giving evidence to conclude that this model was useful in explaining process and outcomes of social exclusion of older persons. [ABSTRACT FROM AUTHOR]