Out-of-pocket expenses in older adults with noncommunicable diseases: a scoping review

Health services become more necessary as the population ages and diseases become more prevalent. Demanding healthcare services can negatively affect a household's economy, depending on the type of insurance and level of financial protection provided by the country's health system. Patient out-of-pocket (OOP) expenses are those the patients must pay for themselves and that are not covered by insurance. In this scoping review, we sought to address OOP expenses and catastrophic expenditures based on international evidence.

An exhaustive literature search was conducted for articles on older adults. The references for each study were manually analyzed, applying a snowball strategy. The initial literature search retrieved 580 references.

Nine articles contained relevant information about OOP expenditures for older adults. Six more were included after a reference search for 15 studies included. Eight articles were retrospective cohort studies, and seven were cross-sectional surveys using national health surveys and logistic regressions. A total of 1,020,459 patients were included across studies; eight studies were from the United States (53%), and most of the analyzed studies depicted inequalities in OOP expenses for medical services. With regard to countries of divergent income, the OOP expenditure was found to be up to 68%.

Financial strain on older adults with noncommunicable diseases (NCDs) is a worldwide issue, particularly in regions with inadequate social support and healthcare coverage. The high costs of medication, home care, and transportation significantly contribute to their expenses, which are areas that public policies need to prioritize.