Role of pension and insurance schemes in healthcare utilisation and catastrophic health expenditure among rural elderly in Bengaluru

Abstract Background Financial vulnerability is a major barrier to healthcare access among the rural elderly in India. Pension and government insurance schemes aim to improve financial risk protection, yet their influence on healthcare utilisation and catastrophic health expenditure remains uncertain. Objectives To estimate the coverage of pension and insurance schemes among the rural elderly, assess their association with healthcare utilisation and catastrophic health expenditure, and explore stakeholder perspectives on accessibility and effectiveness. Methodology A convergent parallel mixed-methods study was conducted from December 2024 to February 2025 in six rural villages of Bengaluru. One hundred elderly individuals aged ≥ 60 years attending geriatric outreach clinics were recruited using convenience sampling. In-depth interviews with local stakeholders were analysed thematically. Associations were assessed using Fisher’s exact test and logistic regression to estimate adjusted odds ratios. Results 56% of participants received old age pensions and 31% had health insurance coverage, while 25% experienced catastrophic health expenditure. Pension receipt was associated with higher healthcare utilisation (OR 3.0, p = 0.089) and lower odds of catastrophic expenditure (AOR 0.42, 95% CI 0.16–1.06), although not statistically significant. Insurance coverage was associated with higher odds of catastrophic expenditure (AOR 2.19, 95% CI 0.84–5.73). Qualitative findings highlighted irregular pension disbursement, administrative barriers and limited awareness of scheme entitlements. Conclusion Pension receipt showed a favourable association with healthcare utilisation and financial protection, whereas insurance coverage did not demonstrate effective protection against catastrophic expenditure. Strengthening implementation and benefit design may improve financial risk protection for rural elderly populations.