Challenges in financing healthcare among elderly population of Karachi

Date of Award


Document Type


Degree Name

Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)


Community Health Sciences


The population of Pakistan is aging with time and it is predicted to rise to 15% by 2050. Elderly people are prone to sickness as they grow older majority suffers from chronic diseases and are also vulnerable to communicable diseases. Frequent illnesses require prompt healthcare but it is only possible if elderly are able to afford medical expenses. In Pakistan, majority of the people have to pay out of pocket (OOP) to avail needed healthcare. Thus, elderly when they have no source of earning are more likely to suffer from OOP medical expense and are exposed to catastrophic health expenditure and impoverishment. Given the dearth of information we conducted this study to determine sources of healthcare financing and burden of healthcare cost on elderly in urban communities of Karachi. Methods: We collected data from two selected urban communities of Karachi on the basis of convenience. Total sample of 223 elderly people of aged >60 years were recruited from Karimabad and Jivani communities. Systematic sampling was done to include every 3rd elderly from households. Information about healthcare cost and income was inquired for previous 12 months period. We estimated the frequencies and percentages of socioeconomic features and sources of healthcare financing of elderly. Mean, median, interquartile range (IQR) of direct healthcare cost and OOP expenditure was calculated. Catastrophic expenditure and impoverishment before and after OOP payments were calculated on the basis of non-subsistence household expenditure, keeping a threshold at 40%. Percentage of catastrophic expenditure, impoverishment before and after OOP payments were compared by using Mann Whitney U test. Results: The major source of healthcare financing among elderly population was OOP payment. Overall, in both the communities 98% of elderly were paying through OOP payments and only 2% of elderly were covered with community medical insurance. In both the communities, expenses were predominantly borne by sons of the elderly. Out of the total elderly from Karimabad and Jivani, including both who sought healthcare and who did not seek healthcare 73% and 91% incurred OOP in Karimabad and Jivani respectively. In Karimabad, the mean outpatient per month direct cost was 6404 PKR (52.06 US$) with SD 4886 PKR (Refer annexure # 4, Table 7). In Jivani, the mean outpatient per month direct cost was 5066 PKR (42.1 US$) and SD was 3726 PKR(Refer annexure# 5,Table 8).67% elderly population was already in impoverishment in Karimabad households and 85% in Jivani households prior to OOP with p-value 0.03. Conclusion: Almost all elderly were provided health care through OOP. The OOP payments leads to financial catastrophe and impoverishment in elderly population of both communities. The study further concluded that substantial proportion was impoverished even before OOP payments in both communities. Therefore, a certain proportion of elderly population could not access healthcare due to lack of finances. Thus, there is need to reduce burden of OOP among elderly by expanding risk pooling and by reducing user fee charges.

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