Abstract
India is experiencing a rapid demographic transition, with the older population (aged 60 years and above) increasing significantly. Currently, older people constitute 8.6 percent of the total population, amounting to 104 million individuals, a figure projected to reach approximately 319 million by 2050. This growth in the older demographic presents profound public health challenges, particularly as ageing is associated with an elevated risk of non-communicable diseases and multi-morbidity. Empirical evidence highlights that more than half of India’s older population is affected by non-communicable diseases, with a quarter experiencing multiple chronic conditions. The burden of these diseases varies across socio-economic groups, place of residence, and gender, underscoring significant disparities in health outcomes.India's healthcare system is under considerable strain as it attempts to meet the specialized needs of its growing older population. Public healthcare facilities, though central to the country’s healthcare framework, are often characterized by inadequate infrastructure, long waiting times, and limited resources. Moreover, access to healthcare is disproportionately skewed, with rural residents, women, and socio-economically disadvantaged groups utilizing fewer services despite having greater needs. The high reliance on private healthcare further exacerbates inequalities, as 65 percent of healthcare costs are borne out-of-pocket, often leading to catastrophic health expenditures and pushing millions into poverty annually.
Within this context, India’s older workforce especially in the informal sector faces compounded vulnerabilities due to precarious employment, limited social security, and rising healthcare costs. This research seeks to explore the interplay between health outcomes, healthcare utilization, and economic burdens among India’s older workforce by their type of economic activity (formal/informal), with the aim of informing targeted policies to address these pressing issues.
Data and Methods
The present study used data from the first wave (2017-18) of the Longitudinal Ageing Study in India. It is a nationally representative survey that collects comprehensive information on the health, economic, and social factors influencing India's ageing population. All analyses were conducted using STATA software, with the primary explanatory variable being the type of work (formal and informal).
1. For the first research question, the key outcome variables were Chronic Health Conditions, Functional Limitations, and Poor Cognitive Functioning. Sequential multiple logistic regression with an interaction term was employed for statistical analysis.
2. In the second research question, the key outcome variable was overall healthcare visits (both inpatient and outpatient). Sequential zero-inflated Poisson regression with an interaction term was used to assess the relationship between type of work and healthcare visits.
3. For the final research question, the outcome variables were out-of-pocket and catastrophic healthcare expenditures. Two-part regression model was applied to estimate out-of-pocket healthcare expenditures for formal and informal older workers, while sequential probit regression models were used to calculate the probability of catastrophic healthcare expenditure by type of work.
Results
The results of multiple logistic regression models show that informal older workers face a higher risk of Poor Cognitive Functioning, while formal older workers are more susceptible to Chronic Health Conditions and Functional Limitations. Regarding healthcare visit frequency, the zero-inflated Poisson regression indicate that informal older workers have fewer healthcare visits compared to formal older workers, particularly affected by depression as well as both Chronic Health Conditions and depression. Moreover, the research estimates the burden of Out-of-Pocket healthcare payments on informal older workers, revealing that while they pay less on average for healthcare services, they experience a disproportionately higher burden compared to formal older workers.
Conclusion
These findings highlight the critical need for policies that address health and healthcare benefits in relation to the economic activity and socio-economic position of older workers. The study emphasizes the importance of providing economic support and ensuring accessible healthcare services to encourage healthcare-seeking behaviours, particularly for older workers from disadvantaged socio-economic backgrounds. To achieve this, strengthening universal health insurance schemes is essential to ensure that everyone can access medical services without facing financial hardship. Special consideration must be given to informal workers, whose livelihoods and healthcare security present unique challenges. This involves reinforcing social security and healthcare systems, along with related policies, to provide financial protection against out-of-pocket payments, not only for informal workers but for the population in general.
| Date of Award | 2025 |
|---|---|
| Original language | English |
| Supervisor | Rachel DAVEY (Supervisor) & Srinivas Goli (Supervisor) |
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