India’s immobile elderly and universal health coverage: insights from 75th round national sample survey

The immobile elderly are one of India’s most vulnerable population subgroups. This study aims to understand the progress towards universal health coverage regarding access to healthcare and financial protection for the immobile elderly in India. This study used data from the 75th Round National Sample Survey, conducted from July 2017 to June 2018 across 8077 rural villages and 6181 urban wards. Data from 555,115 individuals included 42,762 elderly individuals (60 years or above). Bivariate and multivariate analyses were used for the study. In India, 7.5% of the elderly are physically immobile, including 1.4% bedridden, 5.5% confined at home, and 0.6% in a wheelchair. Immobility was higher in urban areas [OR: 1.12 (95% CI: 1.04–1.21), p = 0.003] compared to rural areas, and in the non-literate population [OR: 1.85 (95% CI: 1.63–2.12), p < 0.001 compared to the secondary or above -educated population. The disease burden of psychiatric and neurological disorders was significantly higher in the immobile elderly (hospitalisation: 16.3%, outpatient: 12.6%) compared to the mobile elderly (hospitalisation: 5.2%, outpatient: 3.4%). The private sector was a major service provider (hospitalisation: 61.1%, outpatient care: 66.4%), but public healthcare utilisation was higher among the poor. Out-of-pocket expenditure was high in the immobile elderly compared to the mobile elderly, and the private sector compared to the public sector. There is an urgent need to invest in comprehensive primary healthcare with good referral linkages to tertiary and rehabilitative care for immobile elderly in India. Trial registration: Not applicable.