{"id":"https://openalex.org/W7225638613","doi":"https://doi.org/10.3389/fpubh.2026.1939036","title":"Financial risk and health insurance utilization among older adults in an urban informal settlement in Pune, India: a prospective community-based study","display_name":"Financial risk and health insurance utilization among older adults in an urban informal settlement in Pune, India: a prospective community-based study","publication_year":2026,"publication_date":"2026-11-09","ids":{"openalex":"https://openalex.org/W7225638613","doi":"https://doi.org/10.3389/fpubh.2026.1939036"},"language":"en","primary_location":{"id":"doi:10.3389/fpubh.2026.1939036","doi":"https://doi.org/10.3389/fpubh.2026.1939036","is_oa":true,"landing_page_url":"https://doi.org/10.3389/fpubh.2026.1939036","pdf_url":"https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2026.1939036/pdf","source":{"id":"https://openalex.org/S2595931848","display_name":"Frontiers in Public Health","issn_l":"2296-2565","issn":["2296-2565"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","medline","norway-1","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320527","host_organization_name":"Frontiers Media","host_organization_lineage":["https://openalex.org/P4310320527"],"host_organization_lineage_names":["Frontiers Media"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Frontiers in Public Health","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","doaj"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2026.1939036/pdf","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5161309319","display_name":"Aditya Sharma","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I887998513","display_name":"Bharati Vidyapeeth (Deemed to be University)","ror":"https://ror.org/0052mmx10","country_code":"IN","type":"education","lineage":["https://openalex.org/I887998513"]}],"countries":["IN"],"is_corresponding":false,"raw_author_name":"Aditya Sharma","raw_affiliation_strings":["Department of Community Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Community Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College","institution_ids":["https://openalex.org/I887998513"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5024844880","display_name":"Sanjivani Patil","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I887998513","display_name":"Bharati Vidyapeeth (Deemed to be University)","ror":"https://ror.org/0052mmx10","country_code":"IN","type":"education","lineage":["https://openalex.org/I887998513"]}],"countries":["IN"],"is_corresponding":true,"raw_author_name":"Sanjivani Patil","raw_affiliation_strings":["Department of Community Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Community Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College","institution_ids":["https://openalex.org/I887998513"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5031753201","display_name":"Rupeshkumar Deshmukh","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I887998513","display_name":"Bharati Vidyapeeth (Deemed to be University)","ror":"https://ror.org/0052mmx10","country_code":"IN","type":"education","lineage":["https://openalex.org/I887998513"]}],"countries":["IN"],"is_corresponding":false,"raw_author_name":"Rupeshkumar Deshmukh","raw_affiliation_strings":["Department of Community Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Community Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College","institution_ids":["https://openalex.org/I887998513"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":1,"corresponding_author_ids":["https://openalex.org/A5024844880"],"corresponding_institution_ids":["https://openalex.org/I887998513"],"apc_list":{"value":3150,"currency":"CHF","value_usd":3801},"apc_paid":{"value":3150,"currency":"CHF","value_usd":3801},"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.0,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"14","issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T11531","display_name":"Healthcare Systems and Reforms","score":0.9994999766349792,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T11531","display_name":"Healthcare Systems and Reforms","score":0.9994999766349792,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.00019999999494757503,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T12708","display_name":"Economic and Financial Impacts of Cancer","score":9.999999747378752e-05,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/older-adults","display_name":"older adults","score":0.777999997138977},{"id":"https://openalex.org/keywords/urban-informal-settlements","display_name":"urban informal settlements","score":0.871999979019165},{"id":"https://openalex.org/keywords/health-insurance-utilization","display_name":"health insurance utilization","score":0.9419999718666077},{"id":"https://openalex.org/keywords/out-of-pocket-costs","display_name":"out-of-pocket costs","score":0.9150000214576721},{"id":"https://openalex.org/keywords/catastrophic-health-expenditure","display_name":"catastrophic health expenditure","score":0.9990000128746033},{"id":"https://openalex.org/keywords/financial-protection","display_name":"financial protection","score":0.8809999823570251},{"id":"https://openalex.org/keywords/health-care-expenditure","display_name":"health care expenditure","score":0.5879999995231628},{"id":"https://openalex.org/keywords/morbidity","display_name":"morbidity","score":0.7950000166893005},{"id":"https://openalex.org/keywords/socioeconomic-status","display_name":"socioeconomic status","score":0.7549999952316284},{"id":"https://openalex.org/keywords/financial-dependence","display_name":"financial dependence","score":0.6309999823570251},{"id":"https://openalex.org/keywords/health-insurance-awareness","display_name":"health insurance awareness","score":0.5519999861717224},{"id":"https://openalex.org/keywords/health-insurance-coverage","display_name":"health insurance coverage","score":0.546999990940094},{"id":"https://openalex.org/keywords/india","display_name":"India","score":0.46299999952316284},{"id":"https://openalex.org/keywords/chronic-morbidity","display_name":"chronic morbidity","score":0.6069999933242798}],"concepts":[{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.5353999733924866},{"id":"https://openalex.org/C99454951","wikidata":"https://www.wikidata.org/wiki/Q932068","display_name":"Environmental health","level":1,"score":0.5006999969482422},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.4683000147342682},{"id":"https://openalex.org/C2777895361","wikidata":"https://www.wikidata.org/wiki/Q1758614","display_name":"Longitudinal study","level":2,"score":0.4609000086784363},{"id":"https://openalex.org/C16678853","wikidata":"https://www.wikidata.org/wiki/Q486972","display_name":"Human settlement","level":2,"score":0.4352000057697296},{"id":"https://openalex.org/C2780777579","wikidata":"https://www.wikidata.org/wiki/Q6806347","display_name":"Medical Expenditure Panel Survey","level":4,"score":0.42989999055862427},{"id":"https://openalex.org/C2983635472","wikidata":"https://www.wikidata.org/wiki/Q334911","display_name":"Health insurance","level":3,"score":0.4205999970436096},{"id":"https://openalex.org/C2992462627","wikidata":"https://www.wikidata.org/wiki/Q96382144","display_name":"Informal settlements","level":2,"score":0.3991999924182892},{"id":"https://openalex.org/C144133560","wikidata":"https://www.wikidata.org/wiki/Q4830453","display_name":"Business","level":0,"score":0.3928999900817871},{"id":"https://openalex.org/C149923435","wikidata":"https://www.wikidata.org/wiki/Q37732","display_name":"Demography","level":1,"score":0.3400000035762787},{"id":"https://openalex.org/C74909509","wikidata":"https://www.wikidata.org/wiki/Q10387","display_name":"Gerontology","level":1,"score":0.3395000100135803},{"id":"https://openalex.org/C45355965","wikidata":"https://www.wikidata.org/wiki/Q1643441","display_name":"Socioeconomics","level":1,"score":0.3181999921798706},{"id":"https://openalex.org/C2777063073","wikidata":"https://www.wikidata.org/wiki/Q1553237","display_name":"Settlement (finance)","level":3,"score":0.31220000982284546},{"id":"https://openalex.org/C6422946","wikidata":"https://www.wikidata.org/wiki/Q857354","display_name":"Panel data","level":2,"score":0.30640000104904175},{"id":"https://openalex.org/C73269764","wikidata":"https://www.wikidata.org/wiki/Q954529","display_name":"Poisson regression","level":3,"score":0.30239999294281006},{"id":"https://openalex.org/C205649164","wikidata":"https://www.wikidata.org/wiki/Q1071","display_name":"Geography","level":0,"score":0.29600000381469727},{"id":"https://openalex.org/C187155963","wikidata":"https://www.wikidata.org/wiki/Q629029","display_name":"Occupational safety and health","level":2,"score":0.2858999967575073},{"id":"https://openalex.org/C524218345","wikidata":"https://www.wikidata.org/wiki/Q31218","display_name":"Health economics","level":3,"score":0.2786000072956085},{"id":"https://openalex.org/C47344431","wikidata":"https://www.wikidata.org/wiki/Q1519812","display_name":"Health policy","level":3,"score":0.27399998903274536},{"id":"https://openalex.org/C10138342","wikidata":"https://www.wikidata.org/wiki/Q43015","display_name":"Finance","level":1,"score":0.27239999175071716},{"id":"https://openalex.org/C79544238","wikidata":"https://www.wikidata.org/wiki/Q423243","display_name":"Activities of daily living","level":2,"score":0.2671999931335449},{"id":"https://openalex.org/C3020672099","wikidata":"https://www.wikidata.org/wiki/Q857354","display_name":"Longitudinal data","level":2,"score":0.2615000009536743}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.3389/fpubh.2026.1939036","doi":"https://doi.org/10.3389/fpubh.2026.1939036","is_oa":true,"landing_page_url":"https://doi.org/10.3389/fpubh.2026.1939036","pdf_url":"https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2026.1939036/pdf","source":{"id":"https://openalex.org/S2595931848","display_name":"Frontiers in Public Health","issn_l":"2296-2565","issn":["2296-2565"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","medline","norway-1","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320527","host_organization_name":"Frontiers Media","host_organization_lineage":["https://openalex.org/P4310320527"],"host_organization_lineage_names":["Frontiers Media"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Frontiers in Public Health","raw_type":"journal-article"}],"best_oa_location":{"id":"doi:10.3389/fpubh.2026.1939036","doi":"https://doi.org/10.3389/fpubh.2026.1939036","is_oa":true,"landing_page_url":"https://doi.org/10.3389/fpubh.2026.1939036","pdf_url":"https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2026.1939036/pdf","source":{"id":"https://openalex.org/S2595931848","display_name":"Frontiers in Public Health","issn_l":"2296-2565","issn":["2296-2565"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","medline","norway-1","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320527","host_organization_name":"Frontiers Media","host_organization_lineage":["https://openalex.org/P4310320527"],"host_organization_lineage_names":["Frontiers Media"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Frontiers in Public Health","raw_type":"journal-article"},"sustainable_development_goals":[{"score":0.9940000176429749,"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3"},{"score":0.8928999900817871,"display_name":"No poverty","id":"https://metadata.un.org/sdg/1"},{"score":0.7578999996185303,"display_name":"Reduced inequalities","id":"https://metadata.un.org/sdg/10"}],"study_designs":[{"display_name":"Observational Study","id":"https://openalex.org/study-designs/observational-study"}],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7225638613.pdf","grobid_xml":"https://content.openalex.org/works/W7225638613.grobid-xml"},"referenced_works_count":24,"referenced_works":["https://openalex.org/W1900956557","https://openalex.org/W1937894135","https://openalex.org/W1985366327","https://openalex.org/W2063956631","https://openalex.org/W2112669742","https://openalex.org/W2125849337","https://openalex.org/W2150968783","https://openalex.org/W2730743385","https://openalex.org/W2756449730","https://openalex.org/W2776965044","https://openalex.org/W2780496980","https://openalex.org/W2789892463","https://openalex.org/W2798142707","https://openalex.org/W2926811861","https://openalex.org/W3009432889","https://openalex.org/W4214594246","https://openalex.org/W4281663622","https://openalex.org/W4285033909","https://openalex.org/W4289879048","https://openalex.org/W4395666323","https://openalex.org/W4400453016","https://openalex.org/W4401516183","https://openalex.org/W4406926691","https://openalex.org/W4411131528"],"related_works":["https://openalex.org/W7213556227","https://openalex.org/W4289879048","https://openalex.org/W7168361283","https://openalex.org/W7135178412","https://openalex.org/W4311327454","https://openalex.org/W4400508087","https://openalex.org/W2090274609","https://openalex.org/W1975398584","https://openalex.org/W7212496734","https://openalex.org/W2773623065"],"abstract_inverted_index":{"Background":[0],"Older":[1],"adults":[2,55,71,326],"living":[3],"in":[4,32,56,76,90,174,271,328],"urban":[5,58,77,329],"informal":[6,59,78,330],"settlements":[7,79,331],"are":[8],"vulnerable":[9],"to":[10,101,196],"financial":[11,21,29,352,359],"hardship":[12],"because":[13],"of":[14,86,137,251,273,298,301,342],"chronic":[15],"morbidity,":[16,111,189],"repeated":[17],"healthcare":[18,26,112,118,337,364],"visits,":[19],"and":[20,28,50,117,126,148,162,177,190,214,220,223,243,295,335,362],"dependence.":[22],"Longitudinal":[23],"evidence":[24],"on":[25,108],"expenditure":[27,44,48,119,127,229,338],"risk":[30,360],"protection":[31,361],"this":[33],"group":[34],"remains":[35],"limited.":[36],"This":[37],"study":[38,65],"assessed":[39,142],"health":[40,47,114,343],"insurance":[41,115,212,344],"utilization,":[42,113,116],"out-of-pocket":[43,334],"(OOPE),":[45],"catastrophic":[46,336],"(CHE),":[49],"associated":[51,280,305,349],"factors":[52],"among":[53,68,314],"older":[54,70,325],"one":[57,188],"settlement.":[60],"Methods":[61],"A":[62],"community-based":[63],"longitudinal":[64],"was":[66,131,237,279,312,347],"conducted":[67],"116":[69,167],"aged":[72],"\u226560":[73],"years":[74],"residing":[75,327],"under":[80],"an":[81],"Urban":[82],"Health":[83,211],"Training":[84],"Center":[85],"a":[87,123,201,307],"medical":[88],"college":[89],"Western":[91],"India.":[92],"Participants":[93,254],"were":[94,120,141,154,170,179,216,304],"followed":[95],"for":[96,247,357],"1":[97],"year":[98],"(June":[99],"2024":[100],"May":[102],"2025)":[103],"with":[104,241,255,281,306,350],"quarterly":[105],"assessments.":[106],"Data":[107],"sociodemographic":[109],"characteristics,":[110],"collected":[121],"using":[122,143],"pre-tested":[124],"questionnaire":[125],"recording":[128],"sheets.":[129],"CHE":[130,269,282,311],"defined":[132],"as":[133],"OOPE":[134,236,259],"exceeding":[135],"10%":[136],"household":[138],"income.":[139],"Associations":[140],"chi-square,":[144],"Mann\u2013Whitney":[145],"U,":[146],"Friedman":[147],"Cochran\u2019s":[149],"Q":[150,207],"tests":[151],"(pairwise":[152],"comparisons":[153],"Holm-adjusted),":[155],"modified":[156],"Poisson":[157],"regression,":[158],"multiple":[159],"classification":[160],"analysis,":[161,277],"concentration":[163],"indices.":[164],"Results":[165],"Among":[166],"participants,":[168],"70.69%":[169],"female,":[171],"58.62%":[172],"lived":[173],"joint":[175],"families,":[176],"64.66%":[178],"financially":[180],"dependent.":[181],"At":[182],"baseline,":[183],"75.86%":[184],"reported":[185,217],"at":[186,230],"least":[187,231],"monthly":[191],"prevalence":[192],"ranged":[193],"from":[194],"69.8":[195],"83.6%":[197],"during":[198],"follow-up":[199],"without":[200,262],"significant":[202],"change":[203],"across":[204],"months":[205],"(Cochran\u2019s":[206],"p":[208,266,288],"=":[209,289],"0.069).":[210],"awareness":[213],"coverage":[215],"by":[218],"36.21%":[219],"29.31%,":[221],"respectively,":[222],"10.34%":[224],"(12":[225],"participants)":[226],"had":[227,257],"insurance-covered":[228],"once.":[232],"The":[233,324],"median":[234],"annual":[235],"\u20b910,900":[238],"(IQR":[239],"\u20b94,770\u2013\u20b920,852.5),":[240],"medicines":[242],"hospitalization/special":[244],"appliances":[245],"accounting":[246],"the":[248,299,302,340,355],"largest":[249],"shares":[250],"itemised":[252],"expenditure.":[253],"morbidity":[256,278],"higher":[258,308,351],"than":[260],"those":[261],"(\u20b912,155":[263],"vs.":[264],"\u20b94,800;":[265],"<":[267],"0.001).":[268],"occurred":[270],"38.79%":[272],"participants.":[274],"In":[275],"adjusted":[276],"(aPR":[283],"2.66;":[284],"95%":[285],"CI":[286],"1.40\u20135.04;":[287],"0.003).":[290],"Morbidity,":[291],"lower":[292,296],"socioeconomic":[293],"status,":[294],"education":[297],"head":[300],"family":[303],"OOPE-to-income":[309],"ratio.":[310],"concentrated":[313],"poorer":[315],"households":[316],"(concentration":[317],"index":[318,321],"\u22120.230;":[319],"Erreygers-corrected":[320],"\u22120.357).":[322],"Conclusion":[323],"experienced":[332],"substantial":[333],"despite":[339],"availability":[341],"schemes.":[345],"Morbidity":[346],"significantly":[348],"burden,":[353],"indicating":[354],"need":[356],"strengthened":[358],"geriatric":[363],"services.":[365]},"counts_by_year":[],"updated_date":"2026-11-11T12:16:26.678958","created_date":"2026-11-10T00:00:00"}
