For many Indian families, the heaviest healthcare costs come not only from hospital stays but also from months of caring for an elderly relative at home.

One in five households — 21 per cent — with chronically ill elderly members who require palliative care incurs catastrophic health expenditure, a nationwide study has revealed.

The findings underscore the gaps in health insurance and in government support for long-term care.

“Catastrophic health expenditure” has been defined in the study as health expenditure that equals or surpasses 25 per cent of the household’s income.

The financial strain frequently pushed families into debt — about one in four of the households ran through their savings or took loans to meet the treatment costs. Others relied on financial help from friends and relatives.

“Despite expanding health coverage, older adults with palliative care needs in India remain highly vulnerable to financial hardship because they must rely overwhelmingly on out-of-pocket spending,” Benson Thomas, professor of health economics and study supervisor at the SRM School of Public Health, Chennai, told The Telegraph.

The analysis, just published in the journal BMC Palliative Care, drew on data from 2,903 elderly patients requiring palliative care across 2,698 households spanning all income groups.

Among these households, 24 per cent exhausted their savings, 27 per cent borrowed money, and 14 per cent turned to friends or relatives.

Palliative care focuses on improving the quality of life for people with chronic, life-limiting conditions.

Among older adults, illnesses such as chronic respiratory disorders, cancer, heart disease and stroke commonly require prolonged outpatient care rather than hospital-based treatment.

“We find that financial protection for those with palliative care needs is non-existent or extremely weak,” said Terrymize Immanuel, a researcher at the SRM School of Public Health and member of the study team.

Most health insurance plans in the country, he said, exclude palliative care —
particularly for services delivered at home, where the majority of elderly patients with chronic illnesses receive treatment.

The study found that households, on average, had to bear 94 per cent of outpatient treatment costs and 82 per cent of hospitalisation expenses for elderly patients with chronic illnesses.

The hospitalisation costs over a year averaged ₹2.68 lakh for cancer treatment, ₹93,000 for heart disease, and ₹54,000 for a stroke — conditions most strongly associated with catastrophic spending.

The Union health ministry has said that government-funded healthcare and insurance schemes, including the Pradhan Mantri Jan Aarogya Yojana launched in 2018, have significantly reduced households’ out-of-pocket expenses on healthcare.

The ministry estimates that out-of-pocket expenses fell from 62 per cent in 2014-15 to about 39 per cent by 2021-22.

“But it is unclear whether these gains have extended to the treatment of elderly with chronic health conditions (since they depend heavily on outpatient services),” Immanuel said.

The study also found that the burden of catastrophic health expenditure varied across states.

About 6.5 per cent of households in Karnataka experienced catastrophic expenditure, compared with 23 per cent in Bengal and 38 per cent in Kerala, underscoring regional disparities in access, utilisation and financial protection.