Catastrophic health expenditure among elderly and its risk factors: a critical review 10.55131/jphd/2025/230121
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Abstract
The global elderly population is growing, leading to an increased demand for healthcare services. Consequently, there has been a rise in catastrophic health expenditures (CHE). To address this issue, a desk review was conducted to examine the global factors that contribute to CHE among the elderly by using Andersen’s Behavioral Model of Healthcare Utilization as a framework. This review was performed with the PRISMA guidelines. We searched the Scopus, Web of Science, and PubMed databases for studies on CHE among the elderly population. The search was limited to the period from 1986 to August 2023 by using the keywords “Catastrophic health expenditure” and “Elderly”. Subsequently, an analysis was conducted to examine the trend of the CHE rate and investigate the factors responsible for it. A total of 48 studies were included, with the CHE thresholds ranging from 10% to 60% and incidence rates ranging from 3% to 93.4%. Age, gender, education, and residential setting emerged as significant predisposing factors. Income, hospitalization, and insurance coverage were prominent enabling factors, especially in middle-income countries. The presence of chronic diseases, noncommunicable diseases (NCDs), and disabilities were significant need factors contributing to CHE. The elderly populations worldwide are especially susceptible to CHE due to factors such as a higher incidence of NCDs and chronic illnesses, combined with insufficient health insurance coverage. To reduce the impact, it is crucial to improve preventive care, effectively manage chronic diseases, and address the socioeconomic factors that affect health. In addition, investigating the relationship between mental health, quality of life, and CHE may potentially help in understanding psychological impacts on individuals as well as households.
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