The financial toxicity of ageing: a longitudinal analysis of the health and functional determinants of household OOP spending in rural South Africa

The financial toxicity of ageing is characterised by a "dual burden of exclusion." While NCD diagnoses drive households into the payment system, severe functional and mental decline appears to act as a barrier to access, effectively excluding the most vulnerable from the formal health economy. Financial risk protection mechanisms must be expanded beyond disease-specific models to cover geriatric frailty and disability explicitly.